A 21-year-old woman presented abdominal pain to the emergency department. History: Four pack-year history of tobacco smoking and two previous first trimester miscarriages. 2-week history of abdominal pain with intensity 7/10 and swelling that followed a flu-like illness six weeks earlier. The pain was aggravated by movement and alleviated somewhat by nargsarcotic pain medications. Physical examination: Physical exam at an outside hospital demonstrated the presence of ascites.
Two paracenteses and imaging studies failed to reveal a cause of her ascites. On further physical examination, found that the patient had pale conjunctiva without icterus. Abdominal exam revealed a distended abdomen with normoactive bowel sounds, positive fluid wave, shifting dullness, and increased the liver span of 20 cm in the right midclavicular line and no guarding, rigidity or rebound tenderness. Extremity…
