Ascitic fluid cholesterol level

Last revised by Daniel J Bell on 28 Jan 2021

Ascitic fluid cholesterol level estimation is a simple and precise test for differentiating malignant ascites from non-malignant (cirrhotic) ascites 5-9


Ascites is the abnormal collection of fluid within the peritoneal cavity. Malignant ascites comprises ~10% and is usually secondary to hepatic, endometrial, colorectal, lung, or breast malignancy 3-5. The distinction between malignant and non-malignant ascites is crucial for additional therapeutic and diagnostic procedures 4.5.

The cholesterol level of malignant ascitic fluid is higher, ranging from 70-90 mg/dL, than that of non-malignant ascitic fluid, usually 29-35 mg/dL 1,3,9,11. In tubercular ascites, the mean level of ascites cholesterol was found to be up to 35 mg/dL 8.

Ascitic cholesterol level is also used for differentiating between non-portal hypertensive ascites and in mixed non-portal hypertensive ascites. Therefore, this is a simple measure that may be used in patients with new-onset ascites 3.

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