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Year : 2015  |  Volume : 3  |  Issue : 4  |  Page : 1

New-Onset liver failure: Pitfalls of an unusual diagnosis

1 Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
2 Department of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Correspondence Address:
Francisco Jose Romeo
Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires
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Source of Support: None, Conflict of Interest: None

DOI: 10.5812/acvi.33652

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Introduction: Heart failure is the second most common cause of ascites after cirrhosis. There are cardiac and noncardiac etiologies of ascites, and the multimodality imaging approach is a rich tool to redefine the final diagnosis. Case Presentation: We present a case-series where 3 patients were referred to our hospital for further hepatology assessment due to severe abdominal ascites and liver failure. Constrictive pericarditis was diagnosed in all of them. Nowadays, constrictive pericarditis is a well-known disease, but sometimes its clinical presentation may delay the treatment and worsen the prognosis. Our 3 cases had similar clinical scenarios and hemodynamic patterns when undergoing right-heart catheterization, but they had different anatomical pericardium-compromise, requiring different surgical strategies. Conclusions: Nowadays, multimodality imaging, especially cardiac magnetic resonance imaging and cardiac computed tomography, allows us to study a wide spectrum of the same disease in terms of anatomical compromise and cardiac physiology in order to stratify different prognosis and treatment options. We describe 3 unusual clinical cases where the initial differential diagnosis denoted noncardiac etiologies. The level of serum NT-proBNP proved pivotal to the redefinition of the clinical scenario and differentiation between the cardiac and noncardiac etiologies of new-onset ascites. A multidisciplinary approach in this setting between internists, hepatologists, and cardiologists was helpful to establish the final diagnosis in all the patients.

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