Meig's syndrome

Covert

Step 1: View clinicals

A 56 year old woman presents with worsening dyspnea and abdominal distention for 8 months. Her medical history is unremarkable, while her menopause took place at 52 years of age. She has had 3 uneventful pregnancies. A full blood count and chest x-ray show a hemoglobin level of 13 g/dl and a right sided pleural effusion respectively. A recent mammogram was normal.


Step 2: Order all relevant investigations

Ultrasound abdomen/pelvis

There is a large hypoechogenic homogenous mass (10x9 cm) arising from the right ovary. The uterus and left ovary appear normal. There is moderate ascites. No liver metastases or intra-abdominal lymphadenopathy is seen.

CA-125

The CA-125 level is 50 U/ml (normal: < 35)

Pleural tap

Protein: 1.7 g/dl (s. protein: 6 g/dl) LDH: 30 IU/l (s. LDH: 100 IU/l) Gram & Ziehl-Neelson stains: negative Microscopy: Reactive mesothelial cells Quantiferon test: negative ADA: 28 IU/L (normal: < 40)

Upper + Lower GI endoscopy

No abnormalities are noted


Step 3: Select appropriate management

Exploratory laparotomy
Antituberculous therapy
Steroids
Chest drain


Score: ★★☆