malignant ascites

malignant ascites

Excess peritoneal fluid evoked by malignancy, which causes subdiaphragmatic lymphatic obstruction–eg, of the thoracic duct and ↑ intraperitoneal fluid production Etiology Ovarian, breast, gastric, pancreatic, hepatic, colorectal CA, lymphoma, mesothelioma Clinical Abdominal distension, weight gain, indigestion, dyspnea, orthopnea, tachypnea, intestinal obstruction with N&V Imaging Ground glass appearance, central positioning of small bowel loops, and obscured psoas sign on plain abdominal films; MA is confirmed with ultrasonography, CT, and MRI DiffDx TB, CHF, nephrotic syndrome, hepatic disease, bacterial peritonitis, malnutrition–due to hypoalbuminemia Management Drainage of fluid; intraperitoneal chemotherapy, antibiotics, radioactive colloids, biological response modifiers–eg, IL-2, α-IFN, external-beam RT, and surgical placement of LeVeen or Denver shunts Prognosis Poor