Case of the Week: Bloody Ascites and Gas Under the Diaphragm

The Case of the Week series features a different article from Clinical Cases and Images each week:

Bloody Ascites and Gas Under the Diaphragm

A 39 yo African American male (AAM) with a history of new onset ascites 1 week ago, cirrhosis, and end stage renal disease on hemodialysis (ESRD on HD) is admitted to the hospital from the HD unit after he was found to have fever of 39 C.


A previous CXR from 5 days ago (left); the new CXR (middle); air/fluid level close-up (right) (click to enlarge the images).

He had an ultrasound (U/S) guided paracentesis during which 700 cc of bloody fluid were drained.

What is the cause of Bloody Ascites and Gas Under the Diaphragm?

Read more at Clinical Cases and Images.

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References:
Starting "Case of the Week" Series in Response to Reader Requests. Clinical Cases and Images - Blog, Nov 2008.
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