Case 29

Published on 02/03/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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Case 29

A 53-year-old male with a medical history of type 2 diabetes mellitus, hypertension, hepatitis C infection, end-stage liver disease, and end-stage renal disease, and on chronic hemodialysis is referred for stress testing as a part of a cardiac evaluation prior to consideration for liver and renal transplant.

Adenosine stress/rest Cardiolite imaging was performed. His heart rate increased from 80 to 84 beats/min, and blood pressure changed negligibly from 91/56 to 92/55 mm Hg. He reported no chest pain.

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(Video 1a)

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(Video 2)

Perfusion imaging showed massive ascites, splenomegaly, and a small shrunken liver. There was no abnormality in myocardial perfusion. Left ventricular wall motion and left ventricular ejection fraction were normal (62% poststress images, 70% rest).

Variable degrees of ascites, splenomegaly, and enlarged or shrunken liver are common incidental findings in patients with end-stage liver disease. Readers should be familiar with the scintigraphic appearance of these abnormalities.

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