Simultaneous right-sided volume overload and left-sided hypovolemia in a man with massive ascites and a hydrothorax.
The medical problems presented by an 83-yr-old man with hepatic amyloidosis complicated by massive ascites and a right hydrothorax are described. As a result of right atrial compression limiting right heart filling, the patient simultaneously experienced left-sided hypovolemia with renal and hepatic ischemia while manifesting signs of right-sided congestive failure. Only with a transjugular intrahepatic portosystemic shunt procedure, which eliminated the right atrial compression with resolution of the hydrothorax and ascites, was it possible to improve the other medical condition of this man.
Van Thiel
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DH
Oklahoma Transplant Institute, Baptist Medical Center of Oklahoma, Oklahoma City.
Nadir
A
A
Hassanein
T
T
Wright
H I
HI
D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000150:complications / Q000628:therapy; D001201:Ascites / Q000150:complications* / Q000628:therapy; D001810:Blood Volume; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006876:Hydrothorax / Q000150:complications* / Q000628:therapy; D007511:Ischemia / Q000209:etiology*; D007668:Kidney / Q000098:blood supply*; D008099:Liver / Q000098:blood supply*; D008107:Liver Diseases / Q000150:complications / Q000628:therapy; D008297:Male; D011170:Portasystemic Shunt, Surgical
D004232:Diuretics