Thursday, January 8, 2015


A 35 year old woman is brought in by her boyfriend because of abdominal pain. She's noted to have a fever by the emergency department triage nurse. On exam, you note some abdominal distension, lower extremity edema, jaundice, and confusion. Apparently, these changes have happened over the last few weeks. AST/ALT are in the 400 range, alkaline phosphatase 350, and bilirubin 4. The paracentesis shows high serum to ascites protein gradient.

Challenge: What's the diagnosis?

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RaH said...

not sure if
primary biliary sclerosis, biliary cystadenoma, (or just a cystitis?)

Anonymous said...

what is the answer please.

Craig Chen said...


Budd-Chiari syndrome is hepatic venous outflow obstruction. Here, the CT shows a mottled underperfused liver with collapsed portal veins, ascites (small arrows), retroperitoneal varices (large arrow), enlarged caudate lobe (large arrowhead), collapsed IVC (small arrowhead).

Source: UpToDate.