Obstructive Shock Resulting From Right Atrial Collapse Compressed by Hepatomegaly: A Case Report

TL;DR

A man with liver enlargement and low blood pressure was found to have obstructive shock due to his liver compressing the heart's right atrium.

Contribution

This case report highlights a rare cause of obstructive shock due to right atrial collapse from hepatomegaly.

Findings

Right atrial collapse was observed via ultrasound, caused by an enlarged liver.

The patient's condition improved with fluid and blood transfusion.

Obstructive shock from hepatomegaly can coexist with hemorrhagic shock.

Abstract

A 57-year-old Rohingya man with chronic hepatitis C and a two-month history of abdominal swelling and bilateral leg edema presented to a hospital in a refugee camp. He was hypotensive (75/50 mmHg), and his hemoglobin was 5.3 g/dL. We found melena after admission. Hypotension persisted after intravenous fluid boluses followed by an infusion and transfusion. Point-of-care ultrasound revealed a significant collapse of the right atrium (RA), compressed by an enlarged liver, with a preserved left ventricular ejection fraction. Our assessment was obstructive shock due to RA collapse caused by hepatomegaly, in addition to hemorrhagic shock. Further extracellular fluid and transfusion improved his condition. RA collapse caused by hepatomegaly can cause obstructive shock.

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