Management of Ascites: AJR Expert Panel Narrative Review

Ascites can develop in the setting of a variety of pathologies. The approach to treatment depends on accurate determination of the underlying cause, for which fluid analysis plays a central role. In particular, the serum-ascites albumin gradient serves as a primary diagnostic test for differentiating among causes, with certain additional fluid tests performed based on clinical suspicion. Treatment options range from nonspecific fluid removal, including large-volume paracentesis and placement of tunneled peritoneal catheters, to targeted therapies (e.g., diuretics, TIPS placement, and lymphangiography). Societal guidelines exist for the approach to cirrhotic ascites, but the management of ascites due to other less common causes remains less well defined. The goal of this AJR Expert Panel Narrative Review is to provide guidance for the diagnosis and management of ascites, based on available evidence and our clinical experience.