A 50-year-old male has abdominal pain, fatigue, discomfort, and loss of appetite. What could be the diagnosis?

Question

Hello doctor,

The scans of a 50-year-old male patient presenting with ascites, pericarditis, and also some fluid around his lungs. No known cause at this time. Liver enzymes are normal. Creatinine levels were high in the recent past but currently within the normal range. Heart and lung function is normal. The patient has no history of smoking nor drug abuse. The patient is a social drinker. The patient has recurrent episodes of acid reflux and is currently on Omeprazole for his gastritis. He currently has a non-productive cough which has lasted over a month and continues to be a source of discomfort. In the recent past, the patient experienced frequent episodes of syncope triggered by this cough. A sputum TB test came back negative. However, the ascites fluid culture indicated that it was sterile with high protein content and high levels of white blood cells. It was on this basis that his doctors started him on tuberculosis medication as they suspect he was suffering from abdominal tuberculosis. He has been on this medication for 14 days now. About a week ago, the patient started to develop blood clots in his legs. He is currently on blood thinners for the reoccurring DVTs. Hemoculture results came back today indicating that he had Klebsiella pneumonia. All his vital signs are within the normal range and are stable, with O2s ranging from the lows to mid-90s. The underlying cause of his ascites remains a mystery. Doctors have come to a dead-end with X-rays, ultrasounds, and CT scans. In the meantime, the patient continues to suffer from abdominal pain and discomfort, fatigue, nausea, loss of appetite. We were hoping to obtain some answers from this abdominal CT scan. However, his doctors have reviewed the scan, and they say nothing abnormal could be seen except for the fluid build-up. We are currently looking for a second opinion with the CT scan and a possible diagnosis.

Answer 1

Hi,

Welcome to icliniq.com.

Thanks for writing to us.

I hope the patient is not in much discomfort.

The CT scan images (attachments removed to protect the patient's identity) are showing pericardial effusion and ascites in the right superior perihepatic area, causing mild subcapsular scalloping.

There are a few reticulations in the right lung lower lobe.

There is minimal fluid surrounding the lungs.

There is a likely generalized cause for the above findings.

As klebsiella infection is confirmed on blood culture, antibiotics are to be started to cure the infection.

Discussing about tuberculosis, the ascites fluid can be sent for adenosine deaminase levels, and this is a test that will confirm abdominal and peritoneal tuberculosis.

The cause of DVT (deep vein thrombosis), if recurrent, needs to be discussed in detail. The DVT can be due to factors predisposing to decreased blood flow from the distal veins to the heart, and this can be due to immobility or any problems with blood coagulation.

A general nutritional deficiency also needs to be ruled out in the given presentation of clinical features and images.

Regards.

Answer 2

Hi,

Welcome back to icliniq.com.

Thanks and good wishes for a fast recovery.