Getting Help from Imaging to Solve Atypical Clinical Presentations

In the current issue of CASE, we highlight the value of imaging in reaching the correct diagnosis when clinical presentation is either atypical or nonspecific; for instance, a large atrial tumor presenting with exudative ascites and papillary fibroelastomas manifesting with dyspnea. Ascites from cardiovascular origin is particularly troublesome. Although frequently an expression of abdominal pathology, ascites can be a late manifestation of chronic elevation of atrial pressure. We have had the experience of evaluating a patient with cirrhosis being considered for liver transplant only to find out the patient has calcific constrictive pericarditis. Other cardiac causes need to be considered and early echocardiography can give us the precise