Images of Memorable Cases: Case 92 This 56-year-old alcoholic presented with lethargy and increasing abdominal girth of six months’ duration. Her admitting diagnosis was hepatic cirrhosis. 92. Myxedema ascites This patient’s facial features alone were enough to suggest hypothyroidism. In addition, she had a low-pitched voice, dry skin, and pseudomyotonic deep tendon reflexes. After two months of thyroid replacement therapy, she was asymptomatic and looking like her old self again (images below). Liver biopsy at that point showed normal findings. This case emphasizes that alcoholism plus ascites doesn’t necessarily equal liver disease.