High serum albumin ascites gradient ascites--an atypical presentation of metastatic pancreatic cancer.

Pancreatic adenocarcinoma has less than a 5% 5-year survival rate, and metastatic disease is associated with a median survival of 4.5 months. A typical presentation often includes evidence of biliary obstruction, abdominal pain, jaundice, and weight loss. Significant ascites is not commonly seen at initial presentation and, when present, is typically associated with a low serum albumin ascites gradient (SAAG). We discuss a patient who presented with high-SAAG ascites as her initial presentation, only to be later diagnosed with metastatic pancreatic adenocarcinoma.