A 55-year-old man was admitted with increasing abdominal girth and deteriorating mental status over a one-month period. His medical history included the presence of diabetes mellitus, congestive heart failure, and degenerative arthritis. No history of alcohol abuse was obtained. The history indicated that two siblings had similar, although less severe, complaints.Physical examination revealed a cachetic man, with a metallic gray color to the skin. Tense ascites was noted, but no hepatosplenomegaly. Both testicles were atrophic. Figure 1 is an anteroposterior roentgenogram of the abdomen, Fig 2 is an unenhanced computed tomographic (CT) scan, and Fig 3 is a roentgenogram of the right hand and wrist (oblique).
Both Figs 1 and 2 demonstrate a dense and markedly contracted liver in association with massive ascites. Increased attenuation of the spleen also is present on the CT scan. A single calcified gallstone and adynamic ileus are additional
James G. Flournoy, Mark L. Kutler, Vung D. Nguyen, Robert O. Cone. Ascites and Cardiac Failure in a Diabetic Man. JAMA. 1983;249(7):933–934. doi:10.1001/jama.1983.03330310063033