Meig’s Syndrome: A Triad of Pleural Effusion, Abdominal Ascites and Benign Ovarian Fibroma J Int Transl Med, 2015, 3(1):44-46; doi: 10.11910/2227-6394.2015.03.01.09 Open Access
Case Report
Meig’s Syndrome: A Triad of Pleural Effusion, Abdominal Ascites, and Benign Ovarian Fibroma Yaseen Ali, Amila M. Parekh, Rahul K. Rao, Taseen Ali, Linda S. Schneider, Jordan Garvey, Mirza R. Baig Department of Medicine, Ohio University, 120 Chibb Hall, Athens, Ohio, 45701, United States
ABSTRACT Background: Meig’s syndrome is a rare syndrome characterized by a triad of recurrent pleural effusions, ascites, and the finding of a benign ovarian fibroma on diagnostic imaging and histopathological evaluation. Patients can present with any of the constellation of symptoms attributing to the disease state. With pleural effusions they can present with shortness of breath, chest pressure, dyspnea on exertion; symptoms that can be confused with the exacerbation of congestive heart failure. Ascites can present with abdominal tenseness, pain, bloating, cramping, constipation, and elevated liver enzymes. The finding of a benign ovarian fibroma is found only during diagnostic imaging and histopathological evaluation. Case report: The patients was an 85-year-old female with a recent history of coronary artery bypass graft surgery for her severe coronary artery disease presented with the chief complaint of generalized malaise, abdominal pain, constipation of few days. She was initially scheduled to have her second therapeutic thoracentesis for her recurrent pleural effusion as an outpatient procedure but complained of the former symptoms and was admitted for observation and treatment of her abdominal symptoms. Her recurrent pleural effusions were initially attributed to the complications of her coronary artery bypass graft surgery for her severe coronary artery disease. During the admission and evaluation she was diagnosed with Meig’s syndrome. She underwent a left
Key words:
oophorectomy with total abdominal hysterectomy that led to the resolution of all her symptoms.
Pleural effusion
Conclusion: Meig’s syndrome is a rare syndrome characterized by the triad of recurrent pleural
Ascites
effusions, ascites, and the finding of a benign ovarian fibroma. The diagnosis and knowledge of
Meig’s syndrome
this syndrome holds the key to its treatment. The treatment generally involves the resection of the
Ovarian cancer
ovarian fibroma. After the resection of the ovarian fibroma patients recover from the inconvenient
Fibroma
pleural effusions and ascites with no recurrence or future surveillance needed.
Introduction Pleural effusions due to coronary artery bypass graft surgery for
thoracentesis. In a small unfortunate subset of patients, this
coronary artery disease has been reported in the literature as a
complication ensues and they require long term outpatient
rare complication of the procedure[1]. During our literature search
therapeutic thoracentesis.
the exact mechanism by which this complication develops was poorly understood. Majority of the hypothesis exists attributing
Constipation is a common complaint of patients after surgery
it to the failure of compensatory hemodynamic mechanisms
attributed to the stress of surgery, pain management with opioid,
secondary to surgery [2]. In most patients pleural effusions
alteration in normal circadian rhythm, dietary changes, among
eventually subside and they do not require long term therapeutic
other factors. In most cases, these symptoms last only a few
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J Int Transl Med, 2015, 3(1):44-46 days and are resolved after the inciting factors are no longer present[3]. In our patient, her symptoms unusually were present for weeks after the surgery and were being addressed by her primary care physician as an outpatient. After failing several treatment modalities for her constipation with deep, gnawing, crampy abdominal pain her primary care physician obtained a non-contrast abdominal computed tomography that revealed an unclear abdominal pathology. Her therapeutic thoracentesis scheduled a few days afterwards was canceled and she was sent as an inpatient for further evaluation.
Case Report An 85-year-old Caucasian female with the past medical history of hyperlipidemia, hypertension, hypothyroidism, vitamin D
Figure 1 Computed Tomography Chest with Pleural Effusions
deficiency, chronic kidney disease, moderate carotid stenosis, peripheral vascular disease and coronary artery disease with a recent 3-month history of coronary artery bypass graft surgery complicated with recurrent pleural effusions requiring thoracentesis presented to the hospital complaining of worsening abdominal pain, nausea, vomiting, weight loss, and loss of appetite. With these vague constellations of symptoms she initially presented to her primary care physician’s office. Her primary care physician ordered an abdominal computed tomography scan without contrast due to her chronic kidney disease and was found to have a soft tissue density of the small bowel mesentery off the left hemi abdomen which was read as nonspecific and could have represented soft tissue infiltration or
Figure 2 Computed Tomography Abdomen with Ascites
edema or possible mesenteric infarct by the radiologist. Based on the concerning findings in the initial computed tomography of the abdomen she was referred to our facility for further evaluation of findings by her primary care physician. A repeat computed tomography of the abdomen was performed three days after the initial imaging; which revealed bilateral pleural effusions, ascites with peritoneal thickening, and abnormality of the mesentery throughout (Figure 1, 2, and 3). Furthermore, thickening of the peritoneum, nodular areas of thickening concerning for peritoneal spread of tumor, a hypodense lesion in the left adnexa measuring 2.6×2.6×2 cm with stranding. Due to the contrast contraindications with concerns for the progression of her chronic kidney disease; a pelvic ultrasound was performed. Ultrasound
Figure 3 Computed Tomography Pelvis with Ovarian Mass and Adenopathy
was technically limited however there was an approximately 2.7×2.9×4.1 cm hypo-echoic area noted in the left adnexal region
malignancy including biopsy of the ovarian mass. The pathology
with moderate ascites.
report noted it to be a benign ovarian fibroma. Patient underwent a unilateral salpingo-oophorectomy for the ovarian fibroma
The patient underwent a diagnostic work to rule out ovarian
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with total abdominal hysterectomy, her ascites was resolved
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J Int Transl Med, 2015, 3(1):44-46 with judiciously use of diuretics, and she required a repeat
screening ovarian malignancies such as CA-125, BRCA-1,
thoracentesis for her pleural effusions. In the ensuing weeks her
and BRCA-2 are generally negative but does aid in ruling out
condition improved, she recovered well from the surgery, ascites
neoplasms. Diagnosis generally requires physical examination,
did not recur, and her lung effusions considered to be from her
ultrasound, computed tomography, or magnetic resonance
recent coronary artery bypass graft surgery did not recur.
imaging of the abdomen and pelvis area. Once the diagnosis is established treatment generally requires surgical resection with
Discussion
no established guidelines for long-term surveillance as fewer
There are currently over 30 different ovarian tumors classified according to the type of cell from which they initiate. Cancerous ovarian tumors can start from three common cell types: surface [4]
than 5% of cases are malignant[6].
Lessons Learned
epithelium, germ cells, and stromal cells . Limited to the
Meig’s syndrome is a rare syndrome characterized by the triad
scope of our discussion we will briefly discuss only the benign
of recurrent pleural effusions, ascites, and the finding of a benign
ovarian tumors causing symptoms and their treatment. These
ovarian fibroma. The diagnosis and knowledge of this syndrome
benign tumors can be further classified into functioning and
holds the key to its treatment. The treatment generally involves the
nonfunctioning tumors based on whether they produce hormones
resection of the ovarian fibroma. After the resection of the ovarian
or do not produce hormones [5].
fibroma patients recover from the inconvenient pleural effusions and ascites with no recurrence or future surveillance needed.
Generally patients afflicted with these benign tumors complaint of symptoms related either to tumor burden such
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