A 48 year old lady / woman presents to your clinic with complaints of generalized body swelling over the last 6 months and abdominal distension and swelling of feet.

 A 48 year old lady / woman presents to your clinic with complaints of generalized body swelling over the last 6 months and abdominal distension and swelling of feet.

She gets easily short of breath on walking short distances.

Onexamination,

Her Blood pressure is 140/80 mmHg

She has high BMI of 32

Her JVP is raised.

There is bilateral pitting oedema of her feet.

Abdominal examination shows

Liver is palpable 2 finger breadths under right hypichondrium.

There is also presence of ascites.

Examination of lungs :

Dullness of lung bases on both sides.

Reduced air entry in basal regions.

You order an abdominal ultrasound which is given below :

1 . What are the findings In Ultrasound.

2 . What is the most likely diagnosis in this patient ?

3 . Which further investigations should be done?

4.. Which other cardiac conditions can lead to these findings.

What characteristic physical sign would be present in this patient?

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Answers given in the comments section.

1. What are the findings In Ultrasound.

Passive hepatic congestion / hepatomegaly

Dilated hepatic veins and inferior vena cava

2. What is the most likely diagnosis in this patient ?

Congestive cardiac failure leading to passive hepatic congestion and hepatomegaly .

3. Which further investigations should be done?

Echocardiogram

Chest X ray

ECG

BNP levels

4.. Which other cardiac conditions can lead to these findings

Passive hepatic congestion usually secondary to

Congestive heart failure

Constrictive pericarditis

Right heart failure

Characteristic sign on physical exam

– Hepatojugular reflux