Would you perform a diagnostic paracentesis for first-time ascites in a patient with established CHF or pulmonary hypertension, but without apparent liver or other intra-abdominal disease?  

Typically, yes, I'd recommend and pursue a low‑volume diagnostic tap (for cell count/diff, albumin, total protein ± culture) even if the working diagnosis is cardiac ascites driven by CHF or pulmonary hypertension - exceptions based on goals of care, too small to safely tap, patient prefere...

Great question. Yes, we should perform a diagnostic paracentesis for first-time ascites, even in patients with established CHF or pulmonary hypertension, unless there is an obvious alternative explanation and the procedure is unsafe or technically not feasible. After the etiology is established, rep...