Javed Hafiz, Ahmad Arfa, Rehman Abdul, Wagner Michael, McKnight John E
Department of Medicine, TidalHealth Peninsula Regional, Salisbury, MD, USA.
Department of Pathology, TidalHealth Peninsula Regional, Salisbury, MD, USA.
Am J Case Rep. 2025 Apr 6;26:e946777. doi: 10.12659/AJCR.946777.
BACKGROUND Ascites is a common clinical sign noted in 3% to 4% of hospitalized medical patients. Nearly 94% of patients with ascites have non-malignant etiologies, with the most common being chronic liver disease. Peritoneal mesothelioma is an exceedingly rare malignancy associated with asbestos exposure. Here, we report the case of an elderly man who presented with recurrent loculated ascites and received a diagnosis of peritoneal mesothelioma after a delay of approximately 10 weeks. CASE REPORT A 67-year-old man with a history of asbestos exposure presented with abdominal distension and muscle wasting for 1 month. Initial abdominal CT was notable for smooth liver contour and massive ascites. Ascitic fluid analysis was consistent with low serum albumin-ascites gradient but showed negative cytology for malignant cells. Upper and lower endoscopies did not reveal lesions. Due to recurring ascites, serial abdominal paracenteses were performed, although cytology was negative for malignant cells. Repeat abdominal CT performed after 6 weeks showed worsening loculated ascites, with possible peritoneal carcinomatosis. At this point, percutaneous omental biopsy was performed, which established the diagnosis of peritoneal mesothelioma (75 days after initial presentation). CONCLUSIONS In patients presenting with recurrent ascites and a history of asbestos exposure, it is important to consider the diagnosis of peritoneal mesothelioma. While 94% of patients with ascites have non-malignant etiologies, a small proportion of patients can have malignant ascites. In patients in which the first set of ascitic fluid studies are inconclusive, repeat abdominal paracentesis and omental biopsy or diagnostic laparoscopy should be expedited to avoid delays in diagnosis.
腹水是住院内科患者中常见的临床体征，在3%至4%的患者中可见。近94%的腹水患者病因非恶性，最常见的是慢性肝病。腹膜间皮瘤是一种与石棉暴露相关的极其罕见的恶性肿瘤。在此，我们报告一例老年男性患者，其表现为复发性局限性腹水，在延迟约10周后被诊断为腹膜间皮瘤。
一名有石棉暴露史的67岁男性，出现腹胀和肌肉萎缩1个月。初始腹部CT显示肝脏轮廓光滑，有大量腹水。腹水分析与低血清白蛋白-腹水梯度一致，但恶性细胞细胞学检查为阴性。上消化道和下消化道内镜检查未发现病变。由于腹水反复出现，进行了多次腹腔穿刺术，尽管恶性细胞细胞学检查为阴性。6周后重复腹部CT显示局限性腹水恶化，可能存在腹膜癌转移。此时，进行了经皮大网膜活检，确诊为腹膜间皮瘤（初次就诊75天后）。
对于出现复发性腹水且有石棉暴露史的患者，考虑腹膜间皮瘤的诊断很重要。虽然94%的腹水患者病因非恶性，但一小部分患者可能有恶性腹水。对于初次腹水检查结果不明确的患者，应加快重复腹腔穿刺术和大网膜活检或诊断性腹腔镜检查，以避免诊断延误。
