3rd April 2024

A 62 year old male attends for review after having a one year history of bilateral lower limb oedema and abdominal distension.

A 62 year old male attends for review after having a one year history of bilateral lower limb oedema and abdominal distension. Eight years ago, he had multiple rounds of radiotherapy for oesophageal carcinoma treated. Other past medical history includes hypertension, type 2 diabetes mellitus, and hypercholesterolemia. His regular medications are bumetanide, atorvastatin, metformin, and lisinopril.

On physical examination, the patient is afebrile, blood pressure is 170/90 mmHg, pulse rate is 90/min, and respiration rate is 14. Jugular venous distention is present to the angle of the mandible while seated, with prominent pulsations. Auscultation reveals an early diastolic sound at the apex and vesicular breath sounds bilaterally. The abdomen is visibly distended with ascites and he has bilateral pitting oedema to the level of the thighs. Which of the following is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.