SHM Converge Scientific Abstract ePoster Gallery-Heavy Biases, Heavier Costs

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This case highlights how anchoring bias can delay correct diagnosis and treatment in medically complex patients. A 58-year-old woman with hypertension and end-stage renal disease on hemodialysis was admitted for subacute dyspnea, abdominal pain, and swelling. She had previously been found to have an adnexal mass with ascites and was referred to gynecologic oncology. A large-volume paracentesis removed 1750 mL of ascitic fluid, but only cytology was sent, which was negative.<br /><br />She later underwent robotic hysterectomy and salpingectomy, and pathology showed serous cystadenoma, leading initially toward a diagnosis of pseudo-Meigs syndrome. However, further hospital evaluation suggested a different cause of her ascites. Diagnostic paracentesis showed a SAAG of 1.4, ascitic protein of 4.0, and low neutrophil count. Ultrasound showed coarsened hepatic echogenicity but was otherwise unrevealing. Echocardiography demonstrated preserved ejection fraction with grade III diastolic dysfunction, supporting a diagnosis of acute on chronic heart failure with preserved ejection fraction causing cardiac ascites.<br /><br />The report emphasizes that anchoring bias—the tendency to focus on the first plausible explanation and overlook conflicting data—likely contributed to the missed or delayed recognition of cardiac ascites. In this case, the patient’s ascites was initially attributed to the adnexal mass, and more complete fluid studies were not obtained early. Because ascites in hemodialysis patients is often multifactorial, a broad differential and thorough diagnostic workup are essential.<br /><br />The authors conclude that clinicians should remain alert to anchoring bias, especially in complex presentations, to avoid misdiagnosis and ensure appropriate management. The patient was treated with sacubitril-valsartan, with plans to start an SGLT2 inhibitor as an outpatient.

Asset Subtitle

Claire Sevov

Meta Tag

Author List Bryce Dzubara, Claire Sevov

Category Clinical Vignettes

Concept Anchoring Bias

Concept Cirrhotic Ascites

Concept Cardiac Ascites

Concept Diagnosis

Concept Differential Diagnosis

Distinguished Non-Finalist

Presenter Organization The Ohio State University College of Medicine

Presenting Author Claire Sevov

Track Adult

Keywords

anchoring bias

cardiac ascites

heart failure with preserved ejection fraction

hemodialysis

ascites

adnexal mass

pseudo-Meigs syndrome

diagnostic paracentesis

grade III diastolic dysfunction

serous cystadenoma

Anchoring Bias

Cirrhotic Ascites

Cardiac Ascites

Diagnosis

Differential Diagnosis