SHM Converge Scientific Abstract ePoster Gallery-To Diurese or Biopsy? Vexus to the Rescue

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This case describes a 73-year-old man with pancreatic adenosquamous carcinoma, HFrEF (EF 30–35%), and paroxysmal atrial fibrillation who was admitted for acute on chronic heart failure after developing bilateral leg edema and a 5-pound weight gain. He was initially treated with IV diuresis and thought to be euvolemic, but then developed hepatic encephalopathy and concern for acute liver failure. Liver enzymes had been normal one month earlier.<br /><br />CT of the abdomen and pelvis showed suspected passive liver congestion from right-sided heart failure, along with steatosis and an enlarging pancreatic tail mass, but no biliary obstruction. Gastroenterology evaluated for obstructive, infiltrative, and autoimmune causes, and recommended transjugular liver biopsy for definitive diagnosis.<br /><br />Before biopsy, bedside venous excess ultrasound score (VExUS) was performed and showed severe venous congestion: an IVC measuring 2.0 cm, abnormal hepatic vein Doppler with S-wave reversal, and severely abnormal portal vein Doppler. This supported a diagnosis of congestive hepatopathy rather than primary liver failure. IV diuretics were escalated.<br /><br />After intensified diuresis, liver tests improved and the signs of acute liver failure resolved. Gastroenterology no longer recommended biopsy, and the patient was discharged.<br /><br />The report highlights VExUS as a useful point-of-care ultrasound tool for identifying venous congestion in congestive hepatopathy. It may help avoid unnecessary biopsy and guide more aggressive diuresis when standard physical exam and laboratory findings are nonspecific. The authors emphasize that early recognition is important to prevent progression to cirrhosis and hepatocellular carcinoma.

Asset Subtitle

Fatima Dollar

Meta Tag

Author List Daniela Urueta Portillo, Fatima Dollar, Isiah Gonzalez, Robert Nathanson

Category Clinical Vignettes

Concept Venous Excess Ultrasound Score

Concept Venous Congestion

Concept Congestive Hepatopathy

Concept Point-of-Care Ultrasound

Concept Inferior Vena Cava

Distinguished Non-Finalist

Presenter Organization UT Health San Antonio

Presenting Author Fatima Dollar

Track Adult

Keywords

congestive hepatopathy

VExUS

venous congestion

heart failure

hepatic encephalopathy

acute liver failure

IV diuresis

right-sided heart failure

portal vein Doppler

transjugular liver biopsy

Venous Excess Ultrasound Score

Venous Congestion

Congestive Hepatopathy

Point-of-Care Ultrasound

Inferior Vena Cava