A High Serum-Ascites Albumin Gradient and Mediastinal Fibrosarcoma: A Case Report

Abstract

Accumulation of free fluid in the peritoneal cavity is called ascites. The first step in identifying its etiology is to determine the serum-ascites albumin gradient (SAAG). According to this parameter, a high SAAG is regarded as a gradient greater than 1.1 g/dL. This condition has some differential diagnoses such as liver cirrhosis, Budd-Chiari syndrome, heart failure, and idiopathic portal fibrosis. In the present article, we present a young man with abdominal distention due to a high SAAG. Further evaluation of the abdominal and thoracic cavity revealed a mass in the posterior mediastinum, which had compressed the inferior vena cava and left atrium and led to Budd-Chiari syndrome. Evaluation of the biopsy sample showed fibrosarcoma. Mediastinal fibrosarcomas, though rare, should be considered in the differential diagnosis of mediastinal masses.

Malignant Peritoneal Mesothelioma Presenting with High Protein, High Serum-Ascites Albumin Gradient

“…The high SAAG and the negative cytology were certainly reasons for malignancy to be lower on the list of differential diagnoses initially. Several similar cases of high SAAG ascites ultimately determined to be malignant ascites were found including one with a fibrosarcoma that caused inferior vena cava (IVC) compression and resulting Budd-Chiari syndrome and another in which an ovarian tumor was implicated but no such metastases causing compression nor venous clots were found to explain a reason for portal hypertension [6][7][8]. It was postulated for the latter that fluid from the tumor itself may have been responsible for a falsely high SAAG.…”