A Breath-Taking Triad, Rare Case of Pseudo-Meigs Syndrome in a Patient With Benign Leiomyoma
Recommended Citation
Zahedi S, Almajed M, Antishin S, Bradley P. A Breath-Taking Triad, Rare Case of Pseudo-Meigs Syndrome in a Patient With Benign Leiomyoma. Am J Respir Crit Care Med 2024; 209:A1927.
Document Type
Conference Proceeding
Publication Date
6-1-2024
Publication Title
Am J Respir Crit Care Med
Abstract
Meigs syndrome is a clinical diagnosis based on the triad of ovarian tumors, ascites and pleural effusions. Meigs syndrome is an incredibly rare phenomenon and accounts for only 1% of ovarian tumors; most commonly ovarian fibromas. Pseudo-Meigs is a mimicker of Meigs syndrome occurring when other benign ovarian or pelvic tumors result in the same triad. The pathophysiology of Meigs syndrome is unclear. The most accepted theory is that the tumor results in pressure on the lymphatic system in the abdomen, resulting the accumulation of a transudative ascitic fluid which is subsequently transmitted to the pleural cavity. Since there are known cases of atypical Meigs syndrome, in which pleural effusions are present in the absence of ascites, another theory is that fluid enters the pleural cavity through stromal edema from lymphatic channels. The final postulated theory is that growth hormones such as vascular endothelial factor result in increased capillary permeability and accumulation of transudative fluid. We present a case of a 50-year-old woman who was sent to the hospital after anemia was noted on outpatient labs. Her medical history was notable for uterine fibroids. She reported menorrhagia but had no symptoms otherwise. An ultrasound revealed multiple uterine masses consistent with fibroids. She was hospitalized and managed symptomatically for anemia during which time she developed acute hypoxia. She underwent Chest CTA which revealed pulmonary edema, moderate bilateral pleural effusions, and small-volume ascites. Thoracentesis revealed a transudative effusion; gram stain, wet mount and cytology were all negative. Serum tumor markers including CEA, alpha fetoprotein, carbohydrate 19-9, and CA 125 were all negative. Liver function tests were within normal limits. She subsequently underwent a laparoscopic hysterectomy; biopsy of pelvic masses revealed benign leiomyomas. In the two years after the hysterectomy, she did not have re-accumulation of the ascites or pleural fluid. Newly-identified pleural effusions warrant an extensive workup and astute clinical acumen, especially in the absence of a clear etiology. Uterine tumors are a rare cause of pleural effusions and often understandably overlooked by clinicians. This case highlights the importance of considering uterine tumors when evaluating causes of transudative pleural effusions. Identifying Meigs Syndrome and Pseudo-Meigs Syndrome as potential causative factors allows a pathway towards recurrence prevention. Tumor resection results in resolution of ascites and pleural effusions and saves patients from unnecessary thoracentesis and paracentesis. Eliminating the iatrogenic risks of these procedures, such as pneumothorax, bleeding, infection, and bowel perforation.
Volume
209
First Page
A1927
