Ahmed Khan Chaudhry, Muhammad Azam, Faheem Anwar.
Meig`s Syndrome.
J Coll Physicians Surg Pak Jan ;12(4):255-6.

A case of Meig`s syndrome was diagnosed and operated at surgical department of Combined Military Hospital (CMH), Lahore. Pelvic tumor was excised through laparotomy. Postoperatively pleural effusion and ascites were resolved and the patient remained symptom-free without any further complication.

Case Report: An 18 years old female College student was hospitalized by medical specialist for unresolving symptoms of fever, dry irritative cough and increasing dyspnoea in Combined Military Hospital, Lahore. She developed these symptoms a week ago, had symptomatic treatment but without any improvement. A detailed history did not point to any past illness. She was robust, well built with prominent hirsutism. She had normal menarche at the age of 12 but for the last two years she was having scant irregular menses and was worried about the increasing hair all over the body. Her pulse was 100/minute; BP was 100/70 mm of Hg. Temperature was 100°F and respiratory rate 22/minute. Her chest examination revealed bronchospasm and abdominal examination revealed nontender protuberant full abdomen. She was put on bronchodilators, intravenous antibiotics, steroids and oral antihistamines and cough suppressants. She did not show any improvement in her symptoms. Her blood CP was within normal limits and chest x-ray revealed complete homogenous opaque right hemithorax. To relieve her dyspnoea, an immediate pleurocentesis was performed, which revealed frank haemorrhagic aspirate. One liter of fluid was drained and sent for routine examination, and microscopy for malignant cells and culture/ sensitivity tests. Her unrelenting dyspnoea and haemorrhagic pleural aspirate necessitated further investigations. An ultrasound of abdomen revealed free fluid in peritoneal cavity along with a mixed echogenic mass extending from pelvis well above umbilicus. Uterus was normal in size and ovaries could not be visualized. A peritoneal tap revealed haemorrhagic aspirate that further augmented the mystery of her clinical symptoms. Her general condition further deteriorated with progressive dyspnoea, fever and increasing abdominal distension. An urgent CT scan of chest and abdomen was carried out. There was massive rightsided pleural effusion with mediastinal shift to left side. CT scan abdomen revealed a heterogenous mass about 30 x 30 cms arising from pelvis and extending well above the umbilicus. There was gross ascites. Both pleural and peritoneal aspirations were done to relieve her dyspnoea and abdominal distension. Her Hb and PCV were repeated which showed a fall in Hb from initial 11 gm /dl to 8 gm / dl and her general condition further deteriorated. An emergency surgery for pelvic tumour was planned in order to reveal the cause of falling Hb. Before induction of anaesthesia two units of blood were transfused, about 1500 ml haemorrhagic pleural fluid was aspirated to facilitate right lung expansion. Abdomen was opened by a long midline incision. Almost two-liters of haemorrhagic peritoneal aspirate was drained. There was about 30 cms diameter oval mass arising from left ovary which appeared fleshy and highly vascular with areas of haemorrhage and necrosis. Her uterus and right ovary were normal. Other abdominal viscera were found normal. Complete excision of left ovarian mass was carried out and abdomen was closed without a drain. Postoperatively there was remarkably smooth recovery. Her symptoms of cough and dyspnoea improved. A week later her x-ray chest revealed clear bilateral lung fields with complete clearance of pleural effusion. Meanwhile her CA125 estimation report was received in the range of 378 u/ml (Normal 35 u/ml). Histopathology of the mass revealed a granulosa cell tumour ovary with haemorrhagic necrosis. Patient was completely symptom-free after two weeks of procedure. It was a case of Meig`s syndrome which presented in an atypical manner.

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