Case Presentation:
A 33‐year‐old obese woman presented in respiratory distress 4 weeks after an ovarian cystectomy. She reported a 30‐pound weight gain in the month prior to admission. She had recently been treated with antibiotics and steroids after presenting with similar symptoms. On admission, she was afebrile and tachycardic and had an increased respiratory rate. She had bilateral crackles more pronounced at the base and expiratory wheezes. A CT scan revealed pleural effusions and a right ovarian cyst approximately 6 cm in diameter. It was unclear if this was a remnant of her previous cyst or a new manifestation. Blood cultures and respiratory cultures were negative throughout her hospitalization. An echocardiogram revealed a normal ejection fraction. She was admitted to the intensive care unit and placed on BiPAP, broad‐spectrum antibiotics, steroids, and diuretics. Following 36 hours of treatment, the patient's oxygen saturation improved. The patient continued to improve and was discharged home on diuretics.
Discussion:
Respiratory distress is a condition faced by many hospitalists. Meigs syndrome is an unusual cause of this condition and consists of ascites and hydrothorax associated with an ovarian tumor. The hydrothorax is often bilateral, and both the hydrothorax and the ascites can be either transudates or exudates. The condition can occur with other peritoneal tumors, in which case it is termed pseudo‐Meigs syndrome. The etiology of the ascites and hydrothorax is unclear, and the 2 may be independent of each other. Studies have suggested lymphatic drainage from the lower abdomen can accumulate in the pleural space, and blockage of the pleural lymphatics can result in ascites. In this patient, the diagnosis was elusive because she had presumably had her ovarian pathology removed. Furthermore, her obesity made identification of ascites very difficult. That the patient had received a full course of antibiotics made an infective process unlikely. Treatment of Meigs syndrome in the acute setting is primarily symptomatic. The initial focus is on relief of ascites and hydrothorax, followed by maintenance of a proper fluid and electrolyte balance. Removal of the ovarian pathology usually results in complete resolution of symptoms. Meigs syndrome should be considered by internists treating respiratory distress in the setting of ovarian pathology.
Conclusions:
Meigs syndrome should be considered by hospitalist treating respiratory distress in the setting of ovarian pathology.
Author Disclosure:
A. Oskowitz, none; M. Glass, none.