Highly viscous ascites prompting reconsideration of cardiorenal syndrome in a patient with advanced CKD after TAVI.
Koshi Yamada, Takeo Koshida, Kenichiro Abe et al.
✦ AI-curated · Sources linked
Case in brief
An elderly man with advanced chronic kidney disease and cardiovascular issues developed refractory pleural effusion, ascites, and peripheral edema following transcatheter aortic valve implantation. Despite preserved cardiac output, he experienced worsening renal function with diuretic therapy. Diagnostic paracentesis revealed highly viscous, protein-rich ascitic fluid, leading to the suspicion of pseudomyxoma peritonei, which complicated his volume management.
What made this case unusual
The ascitic fluid was highly viscous and protein-rich, with a low serum-ascites albumin gradient and elevated carcinoembryonic antigen levels, raising suspicion for a mucinous peritoneal process.
Diagnostic / clinical pearl
Clinicians should consider atypical ascitic fluid characteristics and explore non-cardiac, non-renal causes in patients with refractory volume overload, especially after procedures like TAVI.
Why it matters
This case underscores the complexity of volume management in patients with advanced CKD and highlights the need for thorough evaluation of ascitic fluid to identify potential underlying conditions.