Situation 21
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Female patient 24 year-old, chronic renal failure on regular
hemodialysis for 5 years.
She had undergone parathyroidectomy one year ago.
Since 7 months she has suffered from unexplained ascites, so she sought
medical advice and underwent several investigations to find out an
explanation for the ascites but without reaching to its etiology so she
came to our meeting..
The resident presented the case as a problem solving…
Just as we looked at the patient as she was coming to the conference we
knew the clue…………did you know it? See the photo…
Yes!! the clue of the case and the missed crucial physical sign is the
increased jugular venous pressure…look at it..
You can not reach its upper level with positive Kussmaul's sign
(increased JVP on inspiration).
It seems to me that you knew what we want to say…yes it’s a case of
pericardial effusion with systemic venous congestion causing the
ascites...
The patient had multiple abdominal ultrasonographies but from then I
decided to do another one intending to see a characteristic finding…did
you know it?
It is the congested hepatic veins.. do you know what the cause of
pericardial effusion is?
...could be a uremic pericardial effusion that can occur even with
stable dialysis such our case and the treatment chance in this situation
is to do more aggressive dialysis …could be tuberculous or a part from
multi-system disease e.g. SLE that could be the responsible cause of
chronic renal failure etc…..
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