11. Thinking Inside the Box

  1. James C. Pile5,
  2. Thomas E. Baudendistel6 and
  3. Brian J. Harte7
  1. Damon M. Kwan1,2,
  2. Gurpreet Dhaliwal3,4 and
  3. Thomas E. Baudendistel6

Published Online: 21 MAR 2013

DOI: 10.1002/9781118483206.ch11

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

How to Cite

Kwan, D. M., Dhaliwal, G. and Baudendistel, T. E. (2013) Thinking Inside the Box, in Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine (eds J. C. Pile, T. E. Baudendistel and B. J. Harte), John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118483206.ch11

Editor Information

  1. 5

    Departments of Hospital Medicine and Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA

  2. 6

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

  3. 7

    South Pointe Hospital, Cleveland Clinic Health System, Warrensville Heights, Ohio, USA

Author Information

  1. 1

    Division of Cardiology, Kaiser Permanente Medical Center, Los Angeles, California, USA

  2. 2

    Department of Medicine, California Pacific Medical Center, San Francisco, California, USA

  3. 3

    Department of Medicine, University of California, San Francisco, California, USA

  4. 4

    Medical Service, San Francisco VA Medical Center, San Francisco, California, USA

  5. 6

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

Publication History

  1. Published Online: 21 MAR 2013
  2. Published Print: 15 MAR 2013

Book Series:

  1. Hospital Medicine: Current Concepts

Book Series Editors:

  1. Scott A. Flanders and
  2. Sanjay Saint

ISBN Information

Print ISBN: 9780470905654

Online ISBN: 9781118483206

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Keywords:

  • cardiac output;
  • cirrhosis;
  • constrictive pericarditis;
  • liver disease

Summary

This case study highlights many of the features of constrictive pericarditis, the challenges and delay in its diagnosis, and its occasional misdiagnosis as a chronic liver disease. Clinicians may recognize the typical combination of cirrhosis (or suspected cirrhosis), high serum-ascites albumin gradient (SAAG) ascites, and edema as characteristic of advanced intrinsic liver disease. However, they must not be seduced into immediate pattern recognition when contrary evidence—such as elevated neck veins, elevated ascitic total protein, or relatively preserved hepatic synthetic function—accompanies that picture. Under such circumstances, they must remember to think outside the box, or hypothetico-deductively, and bear in mind that the heart may be trapped inside a “box.”