Differential Diagnosis Of Ascites Research Articles

Case Report: Ascites as a rare initial manifestation of eosinophilic gastroenteritis

Introduction Eosinophilic gastroenteritis is a rare disease characterized by gastrointestinal symptoms and peripheral eosinophilia. It can affect any layer of the gastrointestinal tract. Mucosal, muscular, and sub-serosal subtypes of eosinophilic infiltration are distinguished based on their infiltration depth. Ascites is a characteristic feature of sub-serosal eosinophilic gastroenteritis. However, isolated ascites is a very rare presentation of the disease, making diagnosis challenging. Case presentation In this case report, we present a 25-year-old female eosinophilic gastroenteritis patient who initially presented with symptoms and signs of ascites. She also reported seasonal rhinitis, which has been associated with eosinophilic gastroenteritis. She responded effectively to treatment with prednisolone. Conclusions This case report highlights the importance of considering rare diseases like eosinophilic gastroenteritis in the differential diagnosis of ascites. Treatment typically involves dietary modifications and corticosteroids. This case also contributes to our understanding of this rare initial presentation of the disease.

Differential diagnosis of ascites: etiologies, ascitic fluid analysis, diagnostic algorithm.

Ascites is the pathological accumulation of fluid within the peritoneal cavity. It often occurs as results of liver cirrhosis, malignant neoplasia, tuberculous infection, cardiac insufficiency, renal diseases, etc. Determining the etiology is an essential step in the management of patients with new-onset ascites. Abdominal paracentesis with appropriate ascitic fluid analysis is probably the most cost-effective method of determining the cause of ascites. We performed a literature search of PubMed and identified articles published in the field of ascites, to evaluate diagnostic values of various parameters in defining the etiologies of ascites and then provides diagnostic algorithm for patients with new-onset ascites. In patients with ascites, the constituent ratio of underlying etiology varies between developed and developing countries. It is a challenge to define the etiologies of ascites in developing countries. Routine ascitic fluid analysis should include the serum ascites albumin gradient (SAAG), total protein concentration, cell count and differential. Optional ascitic fluid analysis includes cholesterol, fluid culture, cytology, tumor markers, lactate dehydrogenase, adenosine deaminase (ADA), triglyceride, amylase, glucose, brain natriuretic peptide (BNP), etc. Our review evaluated diagnostic values of the above parameters in defining the etiologies of ascites. Diagnostic algorithm established in this review would provide a practical and convenient diagnostic strategy for clinicians in diagnosing patients with new-onset ascites.

Case Report On Diagnosis of Malignancy with Serum-Ascites Cholesterol Gradient

Ascites are the accumulation of fluid in the Abdomen. It happens due to clinical complications from various diseasesthat cause signs and symptoms. Cirrhosis, malignant ascites, and abdominal tuberculosis are the most common causes of ascites.The multiple etiologies of ascites make determining the cause difficult. Several techniques can aid in the differential diagnosis ofascites. However, the techniques are more expensive, invasive, and require more time. As a result, a less expensive and fastermethod of diagnosis, at least as a screening test, would greatly benefit clinicians. Albumin and Cholesterol in serum and ascitic fluidare parameters that would help screen and diagnose cancer. The serum-ascites albumin gradient or gap (SAAG) is a medicalcalculation that helps determine the cause of ascites. In addition, the serum ascites cholesterol gradient (SACG) aids in thedifferential diagnosis.The case study aims to evaluate the significance of serum-ascites cholesterol gradient (SACG) in diagnosingovarian carcinoma. This case report includes a 53-year-old woman who presented to the surgical department with anorexia,indigestion, heartburn, pain or discomfort in the abdominal and pelvic regions, nausea, early satiety, bloating, and weight loss for1 month. She was diagnosed with ovarian carcinoma. The gradients of serum-ascites albumin and serum-ascites Cholesterol werecalculated. Later, the results were compared to Ca-125, an ovarian cancer marker. SAAG showed low sensitivity but high specificityand poor diagnostic performance. Her diagnosis of ovarian carcinoma was confirmed and she was advised to follow up with theoncologist. The current case report will help understand the contribution of the ascitic fluid and serum parameters in a case ofovarian cancer with ascites of unknown etiology.

Utility of human epididymis protein 4 in the differential diagnosis of ascites

Background and aimsHuman epididymal protein 4 (HE4) may be a useful tool in the differential diagnosis of malignant ascites. The aim of this study was to evaluate the diagnostic utility of HE4 for detecting malignant ascites, taking into account the possible false positives identified with adenosine deaminase (ADA), C-reactive protein (CRP), % polynuclear cells (%PMN) and glomerular filtration rate (eGFR). MethodsConcentrations of HE4, ADA, %PMN and CRP were determined in 114 samples of peritoneal fluid and creatinine in serum in order to calculate eGFR. ResultsConcentrations of HE4 presented significant differences (P = 0.028) in benign [median (interquartile range)] [582(372)] pmol/L) and malignant ascites ([8241(367)] pmol/L. Sensitivity was 21.2% and specificity 100%. Significant differences were also observed for HE4 between tumors of gynecological origin ([3165(8769)] pmol/L) and others ([665(663)] pmol/L), with a sensitivity of 67% and a specificity of 100%.Classifying according to possible false positives (ADA > 45U/L, CRP > 50 mg/L, %PMN > 90 and eGFR < 30 mL/min/1.73 m2) at maximum specificity, a sensitivity of 33.3% was obtained for HE4, with a cut-off point of 2660 pmol/L. Without possible false positives (ADA < 45U/L, CRP < 50 mg/L, %PMN < 90 and eGFR ≥ 30 mL/min/1.73 m2), a sensitivity of 37.7% was obtained at 100% specificity for a cut-off point of 1041 pmol/L. Applying these criteria to the entire group, a sensitivity of 36.4% was obtained at maximum specificity. ConclusionsHE4 allows the identification of malignant ascites with moderate sensitivity at maximum specificity. HE4 levels can differentiate between tumors of gynecological origin and others. Classification according to possible false positives increases sensitivity without losing specificity.

Not Your Typical Ascites, Pancreatic Ascites: A Case Report and Systematic Review of the Literature

Background: Pancreatic ascites is a rare entity resulting from pancreatic duct leakage into peritoneum. The most common etiology is chronic pancreatitis or abdominal trauma. Case Presentation: A 23-year-old female with history of chronic pancreatitis secondary to alcohol abuse presented with acute on chronic epigastric pain with unintentional weight loss. Physical exam revealed epigastric and right upper quadrant tenderness without rebound or guarding. Labs were significant for low serum albumin and elevated lipase level. CT of abdomen without contrast demonstrated large volume ascites with normal looking pancreas. MRI of abdomen with intravenous contrast revealed two dilated tubules within the pancreatic neck communicating with the pancreatic duct, representing pancreatic fluid leakage into the peritoneal cavity. Paracentesis was performed yielding large volume of ascitic fluid with high amylase level, characteristic of pancreatic ascites. Patient was managed conservatively with bowel rest and octreotide. Conclusion: Pancreatic ascites is uncommon among the differential diagnosis of ascites. Diagnosis is suspected in a patient with chronic alcoholism or pancreatitis presenting with high amylase exudative ascites and/or pleural effusion. Though limited evidence, interventional therapy especially endoscopic procedure is recommended as initial treatment.

Clinical usage of serum albumin to ascitic fluid albumin gradient and ascitic fluid total protein in pediatric ascites

Abdominal paracentesis is performed as a diagnostic test in children with ascites. Serum albumin to ascitic fluid albumin gradient (SAAG) is frequently used in adults to distinguish types of portal hypertension. We aim to investigate the utilization of SAAG and other biomarkers in determining the etiology of significant ascites in children. In this retrospective study, children aged 0-21 years with significant ascites were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes and medical records during the period 1983-2010. Medical records of children who had abdominal paracentesis were examined in detail. 207 children had significant ascites and of those children, 20 (9.6%) had abdominal paracentesis. Our data showed that high albumin gradient (SAAG ≥ 1.1 g/dL) differentiates causes of ascites secondary to portal hypertension (cirrhosis, hepatic vein outflow obstruction, or congestive hepatopathy) from other causes. In addition, ascitic fluid total protein (AFTP) may help in differential diagnosis of ascites. Children with high SAAG manifest clinical features of portal hypertension including esophageal varices or variceal hemorrhage. Among patients with initially unclear causes of ascites, SAAG and AFTP can provide guidance for appropriate investigations.

Analysis of ascitic fluid in differentiating transudate versus exudate - in a tertiary care centre

Introduction: Ascites is the accumulation of fluid within the peritoneal cavity. Normally, 5-20ml of peritoneal fluid is found between the layers of peritoneum, acting as a lubricant and reducing the friction of organ movement during digestion and bodily movements. The use of serum ascites albumin gradient has out dated the total protein measurement in differentiating transudate from exudate fluid. Analysis is done in two broad spectrums: (1) Biochemical analysis (2) Clinical pathology and Cytological analysis Aim & Objectives: This study was done with the objective to evaluate the ascitic fluid analysis for differentiating transudate versus exudate and also the characteristics of the peritoneal fluid in various causes of ascites. Materials and Methods: In this study, 100 patients of ascites were evaluated for ascitic fluid total protein (AFTP) and Serum Albumin Ascitic Gradient (SAAG) along with ultrasound and other required investigations. Ascitic fluid was obtained by Paracentesis, an invasive sampling procedure to remove fluid or air from the peritoneal cavity for diagnostic or therapeutic purposes. The fluid obtained is sent for analysis. Ascitic fluid analysis is a group of tests used to diagnose the etiology of fluid accumulation. Result: Study shows that ascites due to various aetiology is common among 31-50 years of age group with a slight male predominance. The present study suggests that transudative ascites are more common than exudative ascites with a percentage of 52%. Conclusion: Serum Albumin Ascitic Gradient (SAAG) is much more superior to ascitic fluid total protein (AFTP) in the differential diagnosis of Ascites. Ascitic fluid analysis helps in diagnosing the aetiology of ascites based on the cytological and biochemical parameters. The common aetiology for ascites reported in India is liver cirrhosis. The development of ascites in cirrhotic patients is associated with a mortality of 15% and 44% at one-year and five-year follow-up periods, respecti

Diagnostic Value of Ascitic Fluid Total Protein in Differential Diagnosis of Ascites: A Prospective Multicenter Study

Background: Diagnostic performance of ascitic fluid total protein (AFTP) concentration remained unsettled. Our aim was to determine diagnostic value of AFTP in differential diagnosis of ascites. Methods: 704 consecutive patients with new-onset ascites were prospectively enrolled in this study. Findings: In the training cohort, diagnostic performance of quantitative AFTP assay was superior to that of Rivalta test in differential diagnosis of ascites. At the pre-determined cut-off value of 25 g/L, quantitative AFTP assay was more useful in the differentiation of non-portal hypertensive ascites from portal hypertensive ascites compared with the exudate-transudate classification, area under curve (AUC) of receiver operating characteristic (ROC) curve was 0.958. Quantitative AFTP assay was superior to serum-ascites albumin gradient (SAAG) in the detection of non-portal hypertensive ascites, especially malignant ascites and tuberculous peritonitis. In mixed ascites, AFTP was useful in identifying peritoneal lesions. Interpretation: Assay of AFTP represents a beneficial adjunct to SAAG in non-portal hypertensive ascites and mixed ascites, thus it should be determined in diagnostic workup of the patients with ascites. Funding: This work was partially supported by National Natural Science Foundation of China and Clinical Research Physician Program of Tongji Medical College, Huazhong University of Science and Technology. Declaration of Interest: None. Ethical Approval: Our study was conducted in accordance with the principle of Declaration of Helsinki, and also approved by Ethics committee of Tongji Medical College, HUST. This study was registered with the Chinese Clinical Trial Registry Platform (http://www.chictr.org.cn/) as ChiCTR-DCD-15006907.

Ascitic fluid total protein, a useful marker in non-portal hypertensive ascites.

Diagnostic performance of ascitic fluid total protein (AFTP) concentration remained unsettled. Our aim was to determine diagnostic value of AFTP in differential diagnosis of causes of ascites. Seven hundred four consecutive patients with new-onset ascites were prospectively enrolled in this study. In the training cohort, diagnostic performance of quantitative AFTP assay was superior to that of Rivalta test in differential diagnosis of ascites. At the predetermined cut-off value of 25g/L, quantitative AFTP assay was more useful in the differentiation of non-portal hypertensive ascites from portal hypertensive ascites compared with the exudate-transudate classification, area under curve of receiver operating characteristic curve was 0.958. Quantitative AFTP assay was superior to serum-ascites albumin gradient in the detection of non-portal hypertensive ascites, especially malignant ascites and tuberculous peritonitis. In mixed ascites, AFTP was useful in identifying peritoneal lesions. Ascitic fluid total protein is a useful marker in non-portal hypertensive ascites; thus, it should be determined in diagnostic work-up of the patients with ascites.

Value of ascitic fluid lipids in the differentiation between cirrhotic and malignant ascites

Background: The diagnosis of malignant ascites can be difficult. The overall sensitivity of cytology smears for the detection of malignant ascites is 58%–75%. There is a debate about the role of ascitic fluid lipids and their gradients in the differential diagnosis of ascites. This study aims to evaluate the role of ascitic fluid lipids and their gradients in the differentiation of malignant ascites from cirrhotic ascites. Patients and Methods: Ninety-six patients were enrolled in this study divided into two groups according to the cause of ascites; Group I: included 48 patients with malignant ascites and Group II: included 48 patients with cirrhotic ascites. Results: Ascitic fluid cholesterol, triglycerides, and phospholipids were significantly higher among patients of Group I (77.5 ± 11.5, 82.4 ± 17.04 mg/dl, and 0.92 ± 0.14 mmol/L vs. 27.7 ± 7.5, 56.2 ± 16.2 mg/dl, and 0.33 ± 0.09 mmol/L in succession P

The correlation between cytological examination of ascitic fluid and serum ascites albumin gradient in the differential diagnosis of Ascites

Aim: The accumulation of fluid in pathological quantities in the peritoneal cavity is called ascites. In every newly diagnosed ascites, necessary investigations should be conducted by puncturing ascitic fluid. In this study, we aimed to investigate whether there is any correlation between cytological examination of ascitic fluid and serum ascites albumin gradient (SAAG) in the determination of etiologic causes of ascites. Material and Method: The files of the patients who were admitted to our clinic for the investigation of their ascites etiology between May 2014 and May 2018, were analyzed retrospectively. Pathology reports of the patients whose SAAG was calculated by taking the difference between serum albumin values and simultaneously taken ascitic fluid albumin and whose ascitic fluid cytology examination was performed, were recorded. The data of 248 patients with clinical diagnosis were included in the study. Patients with SAAG

Ascitic cholesterol is superior to serum‐ascites albumin gradient in the detection of non‐portal hypertensive ascites and the diagnosis of mixed ascites

The diagnostic value of ascitic cholesterol in the differential diagnosis of ascites is controversial. To investigate the diagnostic performance of ascitic cholesterol in the differential diagnosis of ascites. Consecutive patients with new-onset ascites were enrolled prospectively. The pertinent data were collected from 629 patients with all forms of ascites. In the training cohort, determination of the ascitic cholesterol level was a highly effective method of distinguishing non-portal hypertension (NPH) from portal hypertension (PH). At the pre-determined cut-off value of 45mg/dL, the sensitivity of ascitic cholesterol was superior to the serum-ascites albumin gradient (SAAG) in identifying NPH-related ascites; the area under the receiver operating characteristic curve was 0.945. In the patients misdiagnosed based on SAAG classification, the diagnostic accuracy of ascitic cholesterol was 69%. The ascitic cholesterol level showed excellent performance in identifying peritoneal lesions in patients with mixed ascites. Ascitic cholesterol is an excellent measure for detecting NPH ascites and for identifying peritoneal lesions in mixed ascites. Thus, this simple and cost-effective measure should be determined in patients with new-onset ascites (www.chictr.org.cn; ChiCTR-DCD-15006907).

Study the usefulness of ascitic fluid cholesterol level in diagnosis of malignant related ascites

Background: The differential diagnosis of ascites is a common clinical problem. However, the capability to distinguish malignant from non-malignant causes of ascites using available biochemical techniques would obviate many expensive and time-consuming diagnostic studies on patients presenting with ascites of unknown etiology. Therefore, this study was planned to evaluate usefulness of ascitic fluid cholesterol level in diagnosis of malignant ascites.Methods: Author conducted an observational study in 80 patients, those admitted and willing to give consent in the department of Medicine, LLR and Associated Hospitals, GSVM Medical College, Kanpur from December 2015 to October 2017. All patient underwent full investigations to make the diagnosis of ascites malignant (20) and non-malignant (n=54), tubercular (7) and non-tubercular (47) groups. Six patients were excluded because the ascitic fluid analysis was suggestive of bacterial peritonitis. The data was processed in MS Excel and analysis was carried out using SPSS (23th version).Results: Author found that the mean value of ascitic fluid cholesterol in malignant group was 100.85+34.28 vs 6.7+2.5 in non-malignant group (p value &lt;0.01) and the mean value of ascitic fluid cholesterol in malignant group was 100.80+34.28 vs 32.43+15.7 in tubercular group, so ascitic fluid cholesterol is highly specific (100%) and sensitive (65%) at cut off value of 100mg/dl in differentiating benign and malignant cause of ascites.Conclusions: Ascitic fluid cholesterol having high specificity, can be used for differentiating between non-malignant and malignant ascites. It can also be used to differentiate tubercular ascites from malignant ascites.

Role of imaging in diagnosis and differential diagnosis of ascites from large abdominal cystic masses

Role of imaging in diagnosis and differential diagnosis of ascites from large abdominal cystic masses

Comment on 'Ascitic Fluid Analysis in the Differential Diagnosis of Ascites: Focus on Cirrhotic Ascites'.

Comment on 'Ascitic Fluid Analysis in the Differential Diagnosis of Ascites: Focus on Cirrhotic Ascites'.

A Comparative Study of Serum-Ascitic Fluid Albumin Gradient (SAAG) and Ascitic Fluid Total Protein (AFTP) as a Diagnostic Parameter in Patients Having Ascites

Ascites is a manifestation of various number of diseases and the aetiopathogenesis of ascites is varied. The differential diagnosis of ascites remains a clinical problem. Although cirrhosis is the cause of ascites in most patients (80%), approximately 20% have a cause other than liver disease. Approximately 5% of patient with ascites have more than one cause (i.e. ‘mixed’ ascites). The present study was conducted on 75 consecutive patients admitted to indoor wards, Department of Medicine, Mayo Institute of Medical Science, Barabanki (UP), between June 2015 to May 2016 of age group 18–70 years having clinical symptoms and signs of ascites. Samples of blood and ascitic fluid were obtained simultaneously. The aim of present study was to evaluate various parameters especially serum ascitic fluid albumin gradient in case of ascites in an Indian setting and to compare the SAAG with the AFTP levels in terms of usefulness in establishing a cause of ascites. In the present study value of SAAG was 1.56 ± 0.37 gm/dl (mean ± standard deviation) for patients with portal hypertension related ascites whereas for non-portal hypertension related ascites excluding cardiac ascites SAAG was 0.95 ±0.14 gm%. Corresponding values for cirrhosis and cardiac ascites were 1.6 ± 0.39 gm/dl and 1.44 ± 0.21 gm/dl respectively. It was observed that SAAG in cardiac ascites group (even though placed in non portal hypertension related ascites group based on absence of portal hypertension) resembled the SAAG of portal hypertension related ascites group. It was concluded from our present study that serum ascitic fluid albumin gradient(SAAG) is a better diagnostic parameter than ascitic fluid total protein (AFTP) in the patients having ascites. During the study we observed that SAAG has greater sensitivity and specificity values in comparision to AFTP for detection of portal hypertension related ascites.

C-reactive protein and insulin-like growth factor-1 in differential diagnosis of ascites.

Insulin-like growth factor-1 (IGF-1) and C-reactive protein (CRP) are produced mainly by the liver; the output of these markers in response to inflammatory processes may be affected in patients with hepatic dysfunction. This may explain the differences in IGF-1 and CRP values in patients with non-portal and portal hypertension ascites. We aimed to evaluate serum and ascitic fluid IGF-1 and CRP as diagnostic markers in the differential diagnosis of benign and malignant ascites. In this prospective study, 398 consecutive patients with ascites were included. Serum and ascitic fluid levels of IGF-1 and CRP were measured using an enzyme-linked immunosorbent assay. Patients were divided into group 1, due to benign ascites (n = 324), and group 2, due to malignant ascites (n = 74). Serum and ascitic IGF-1 were significantly increased in malignant ascites than benign ascites group [305 ± 65.7 ng/mL vs 95 ± 53.8 ng/mL; P < 0.001 and 288 ± 54.7 ng/mL vs 83.2 ± 36.7 ng/mL; P < 0.001], respectively. Serum and ascitic CRP were significantly higher in malignant ascites than benign ascites patients [12.8 ± 6.3 mg/mL vs 6.1 ± 4.9 mg/mL; P < 0.001 and 5.1 ± 2.2 mg/mL vs 1.6 ± 1.3 mg/mL; P < 0.001], respectively. At a cutoff value of 309.4 ng/mL and 7.8 mg/mL, serum IGF-1 and CRP had (95.1%, 81%) sensitivity and (88.6%, 75.5%) specificity for detecting malignant ascites [area under the curve: 0.932, 0.845], respectively. At a cutoff value of 291.6 ng/mL and 2.6 mg/mL, ascitic IGF-1 and CRP had (94.6%, 84%) sensitivity and (83.2%, 80.3%) specificity for detecting malignant ascites (area under the curve: 0.911, 0.893) correspondingly. Elevated serum and ascitic fluid IGF-1 and CRP levels were associated with malignant ascites.

A Novel Combination of C-Reactive Protein and Vascular Endothelial Growth Factor in Differential Diagnosis of Ascites.

Ascites with unknown cause remains a diagnostic challenge, which needs novel noninvasive biomarkers for the precise diagnosis. We aimed to evaluate the ascitic fluid and serum C-reactive protein (CRP) and vascular endothelial growth factor (VEGF) as diagnostic markers in the differential diagnosis of malignant and benign ascites. In this prospective work, 315 consecutive patients with ascites were studied. Ascitic fluid and serum levels of CRP and VEGF were evaluated by using an enzyme-linked immunosorbent assay. Patients were divided into a benign ascites group (group 1) (n=256) and a malignant ascites group (group 2) (n=59). Ascitic and serum CRP were significantly elevated in malignant ascites than benign ascites group [5.08 (3.62-6.58) vs. 1.82 (0.64-3.86) ng/ml; P<0.001 and 12.7 (8.55-17.05) vs. 5.94 (2.57-10.64) ng/ml; P<0.001], respectively. Ascitic and serum VEGF were significantly increased in malignant ascites than benign ascites patients [0.68 (0.39-0.96) vs. 0.41 (0.25-0.83) ng/ml; P<0.001 and 0.74 (0.41-1.08) vs. 0.54 (0.23-0.86) ng/ml; P<0.001], respectively. At a cutoff value of 7.3 and 0.63ng/ml, serum CRP and VEGF had specificity (77.3 and 89.5%) and sensitivity (83.1 and 94.9%) for detecting malignant ascites [area under the curve (AUC) 0.821, 0.921], respectively. At a cutoff value of 2.5 and 0.57ng/ml, ascitic CRP and VEGF had specificity (81.6 and 85.5%) and sensitivity (84.7 and 91.5%) for detecting malignant ascites (AUC 0.842, 0.894), respectively. Elevated ascitic fluid and serum CRP and VEGF values were related to the malignant ascites.

腹腔鏡下手術が結核性腹膜炎の診断に有用であった1例－結核性腹膜炎の診断と感染対策－

A 79-year-old woman who had diabetes mellitus, dementia, and breast cancer was referred to our hospital because of ascites. She had no respiratory syndrome. Blood tests revealed an elevated CA125 level (1,224 U/mL), but other tumor markers were within their normal limits. Chest radiography and abdominal computed tomography (CT) detected no signs of malignancy or tuberculosis, but positron emission tomography/CT disclosed abnormal FDG uptake in the omentum, mediastinal lymph node, and diaphragm. Microbiological testing and cytological examination of ascites yielded negative results. We conducted diagnostic laparoscopy while wearing N95 masks and found numerous tiny nodular lesions on the peritoneal surfaces. Pathological examination showed epithelioid granuloma and Langhans giant cells with caseous necrosis, which are characteristic to tuberculosis. Although the Ziehl-Neelsen staining result was negative, interferon-gamma release assays were positive. Tuberculous peritonitis (TBP) was diagnosed, and a combination drug regimen of isoniazid, rifampicin, and pyrazinamide was administered. She has been free from recurrence since the completion of chemotherapy. Throughout the clinical course, Mycobacterium tuberculosis was undetected. TBP is a form of abdominal and pelvic tuberculosis that accounts for about 0.04% of all cases of tuberculosis. The risk is increased in patients with cirrhosis, acquired immune deficiency syndrome, diabetes mellitus, steroid use, or underlying malignancy, and those undergoing continuous ambulatory peritoneal dialysis. TBP, which might be confused with widespread ovarian cancer, should be included in the differential diagnosis of ascites. Because preoperative diagnosis of TBP is difficult, laparoscopic surgery is helpful to distinguish TBP from ovarian cancer. We also suggest the importance of assessing the risk of infectiousness of TBP patients.

Retraction note: New proposal for the serum ascites albumin gradient cut-off value in Chinese ascitic patients.

Serum ascites albumin gradient (SAAG) has been recognized as a reliable marker in the differential diagnosis of ascites. The etiological background of cirrhosis is rather different between western countries and eastern countries. The threshold of SAAG in Chinese ascitic patients has not been evaluated yet. The aim of this study was to define a new reasonable threshold of SAAG in Chinese ascitic patients. Adult patients with ascites admitted to the Shanghai Changzheng Hospital from Jan 2004 to Jun 2010 were retrospectively analyzed. The diagnostic criteria for cirrhotic ascites are clinical manifestations, radiological features and esophageal-gastric varicosis, or histopathology. Serum was detected by chemical method using a commercial kit. We used receiver operating characteristic (ROC) analysis to achieve maximal sensitivity and specificity of SAAG. The mean value of SAAG in portal-hypertension-related ascites was significantly higher than that in the non-portal-hypertension-related ascites (21.15 ± 4.38 g/L vs 7.48 ± 3.64 g/L, P = 0.002). The SAAG cut-off value under 12.50 g/L predicted portal hypertension ascites with the sensitivity of 99.20%, specificity of 95.10% and accuracy of 97.65%. SAAG is useful to distinguish portal-hypertension-related ascites and non-portal-hypertension-related ascites, and 12.50 g/L might present as a more reasonable threshold in Chinese ascitic patients. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1602582638991860