A
56-year-old-male is referred to you because of generalized edema and
increasing abdominal girth. Eight years ago, the patient underwent 5-vessel
coronary artery bypass (CABS) surgery. Six years, he underwent radiation
therapy for lymphoma. Comormidities include Type II diabetes mellitus,
hyperlipidemia and tobacco abuse. He has 2-pillow orthopnea and mild
exertional dyspnea but denies paroxysmal nocturnal dyspnea (PND) and
recurrance of angina.
Physical examination reveals marked anasarca. BP is 100/60
mm Hg. Pulse is 80/min and regular. Neck veins are distended to the
angle of the jaw in the sitting position. There are no murmurs but an
extra sound is noted in early to mid-diastole. Breath sounds are diminished
at the bases.Tyhere are no rales. Abdominal girth is increased and there
is a fluid thrill with shifting dullness. There is scrotal edema and
3+ pitting edema of the legs.
What is the most likely diagnosis?