Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843

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Elderly Man With “Overalls” Edema
Hitoshi NakayaRyuji OkamotoKazunori NagashimaYuichi SuginoYoshito OgiharaHajime SakumaKaoru Dohi
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JOURNAL OPEN ACCESS FULL-TEXT HTML Advance online publication

Article ID: CJ-21-0700

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A healthy 88-year-old man developed leg and scrotal edema and visited a hospital 3 months prior to the current presentation. Loop diuretics and compression stockings were prescribed under a diagnosis of idiopathic edema. However, almost no effect was observed. Lower body edema developed and extended to the waistline and chest wall to the point where he could not move freely. His family brought him to our hospital, where physical examination revealed systemic edema, especially in the lower extremities and trunk in a form he described as “overalls” (Figure A). Blood pressure was 128/65 mmHg, pulse rate was 75 beats/min and oxygen saturation was 97%. ECG showed sinus rhythm and low voltages in the limb and precordial leads (Figure B). Contrast-enhanced computed tomography (CT) showed large polycystic liver disease (PCLD) and compression of the inferior vena cava (IVC) (Figure C,D). Echocardiography showed compression of the right atrium (RA) in addition to the IVC (Figure E). Renal and liver functions were normal. Right heart catheterization and cavography demonstrated stenosis of the IVC and RA with a pressure gradient from 22 to 13 mmHg (Figure F). We diagnosed right heart failure due to PCLD. After CT-guided drainage of 1.5 L of red, non-transparent exudate (Figure G,H) followed by sclerotherapy, a large volume of urine was passed and edema dramatically improved with 21.1 kg of weight loss (Figure I). The patient was discharged home in an ambulant state.

Figure.

(A) Physical appearance and (B) ECG on admission. (C,D) Contrast-enhanced computed tomography shows polycystic liver disease (PCLD, *) and compression of the inferior vena cava (IVC) and right atrium (RA) (red arrowheads). (E) Echocardiography demonstrates compression of the RA by liver cysts (*). (F) Cavography shows compression of the IVC by PCLD (red arrowheads), and data from right heart catheterization show a significant pressure gradient between the lower and middle IVC. (G) Computed tomography-guided aspiration of PCLD (*). (H) Aspirated fluid from PCLD. (I) Physical appearance on discharge. LA, left atrium; SVC, superior vena cava.

Disclosures

H.S. is a member of Circulation Journal’s Editorial Team.

 
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