Ascites due to right-sided heart failure in dogs
11-year-old mixed-breed dog with MMVD and severe tricuspid regurgitation. Progressive abdominal distension, jugular distension and positive hepatojugular reflux. Abdominocentesis is performed and the fluid analysed:
| Parameter | Result | Reference |
|---|---|---|
| Appearance | Pale yellow, slightly cloudy | — |
| Fluid total protein | 3.6 g/dL | — |
| Nucleated cells | 1,400/µL | — |
| Cytology | Macrophages, mesothelial cells and non-degenerate neutrophils; no bacteria | — |
| Serum albumin | 2.9 g/dL | 2.6–4.0 |
Which interpretation is correct?
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A. Transudate due to hypoalbuminaemia; look for renal or gastrointestinal protein loss
Serum albumin is normal and the fluid is protein-rich. Ascites from hypoalbuminaemia is a protein-poor transudate (< 2.5 g/dL) and usually appears with albumin < 1.5 g/dL.
B. Septic exudate requiring urgent surgery
Cellularity is low and there are no degenerate neutrophils or bacteria. A septic exudate would be highly cellular (usually > 5,000–10,000/µL) with low glucose relative to blood.
C. Protein-rich modified transudate from post-sinusoidal hepatic congestion: consistent with right-sided heart failure
Correct. Raised central venous pressure congests the hepatic sinusoids and protein-rich hepatic lymph leaks out. Together with jugular distension and hepatojugular reflux, this points to right-sided heart failure.
D. Pure transudate due to presinusoidal portal hypertension (e.g. a portosystemic shunt)
Presinusoidal portal hypertension produces a protein-poor fluid and does not explain jugular distension. The high protein content indicates a post-sinusoidal origin.
lightbulb Key takeaway
Diuretics mobilise ascites slowly; if it is tense and compromises breathing or comfort, periodic therapeutic abdominocentesis is a useful adjunct in stage D. Always look for the cause of right-sided failure: pulmonary hypertension, pericardial effusion, tricuspid dysplasia, heartworm or Angiostrongylus vasorum.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.