Chylous Ascites as a Rare Manifestation of Congestive Cardiac Failure in a District Hospital

Abstract

Chylous ascites is an uncommon type of ascites which may be associated with liver diseases, tuberculosis or malignancy. However, in a minority of cases, it is due to heart failure. This case report describes a 59 year old Malay gentleman who presented with multiple episodes of abdominal distension for the past six months associated with exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea and bilateral leg swelling. He denied having any fever, night sweats, anorexia or loss of weight. He did not exhibit any altered bowel habit or vomiting. Physical examination revealed a non tender, distended abdomen with an everted umbilicus. His legs were swollen bilaterally till the knees. Jugular venous pulsations were raised. Lungs revealed bibasal crepitations. Abdominal paracentesis showed milky turbid appearing peritoneal fluid. Laboratory studies revealed an exudative chylous ascites. Tuberculous workout, serum tumor markers and viral hepatitis screening were negative. His transthoracic echocardiogram revealed global hypokinesia with a left ventricular ejection fraction of 30%. Contrast Enhanced Computed Tomography scan of the thorax, abdomen and pelvis showed features consistent of liver cirrhosis with portal hypertension most probably attributable to the severe heart failure. There was no evidence to suggest malignancy. He was started on anti-heart failure drugs in which his ascites showed significant improvement within three months. Congestive cardiac failure should be considered as one of the causes for chylous ascites.