Hemorrhagic ascites as a complication of heart failure: A case report and review of the literature

Abstract

Introduction: Although ascites is a common complication of congestive heart failure, the association between heart failure and hemorrhagic ascites is quite rare.Patient concerns: A 64-year-old woman with recurrent large bloody ascites secondary to heart failure.Diagnosis: Ascitic fluid assessment revealed red blood cells of 75,125/mm 3 and white blood cells of 225/mm 3 . The total protein in the ascitic fluid was 28.7 g/L, with a high serum ascites albumin gradient. Peritoneal fluid examinations for bacterial culture, acid-fast bacilli (smear and culture), and malignant cell cytology were negative. Interventions:The patient was managed with therapeutic paracentesis, aggressive diuresis, and optimization of her heart failure medications.Outcomes: The patient's symptoms improved dramatically and was discharged in a stable condition. Conclusion:Congestive heart failure should be considered as a potential cause of hemorrhagic ascites after ruling out other serious causes.Abbreviations: AFB = acid-fast bacilli, AFP = alpha-fetoprotein, HF = heart failure, NT-proBNP = N-terminal pro-brain-type natriuretic peptide, PET = positron emission tomography, RBC = red blood cells, SAAG = serum ascites albumin gradient, TTE = Transthoracic echocardiography.