Background
Meigs’ syndrome is a rare disease characterized by a triad of presentations, including benign ovarian tumor, ascites, and pleural effusion. However, a clinical diagnosis of Meigs’ syndrome remains challenging because pleural and ascitic effusions can be common findings in a variety of underlying conditions. Furthermore, these findings can often be misdiagnosed as pleural and peritoneal dissemination caused by potentially malignant tumors, leading to the administration of improper treatment.
Case presentation
We described a case of an 85-year-old postmenopausal female patient with atypical Meigs’ syndrome presenting with right-sided pleural effusion, notable leg edema, and trivial ascites, which was initially mistaken as heart failure with preserved ejection fraction. However, pleural effusion was totally ineffective against diuretic therapy. Subsequently, thoracentesis yielded serosanguineous exudative effusion. Moreover, refractory pleural effusions and abdominal/pelvic computed tomography and magnetic resonance imaging findings strongly suggested bilateral malignant ovarian tumors with pleural dissemination. Repetitive negative cytological results allowed the patient to undergo bilateral salpingo-oophorectomy. Finally, a definitive diagnosis of Meigs’ syndrome was made by confirming the presence of a benign mitotically active cellular fibroma of the ovary by pathology and that pleural effusion resolved following tumor resection.
Conclusions
Our case highlights the clinical importance of assessing Meigs’ syndrome in the diagnostic workup of pleural effusion in postmenopausal female patients. Given the favorable prognosis of Meigs’ syndrome, clinicians should consider surgical resection, even with potentially malignant ovarian tumors with accompanying pleural effusion, ascites, or both.
a b s t r a c tVentricular fibrillation (VF) is an important cause of sudden cardiac death in patients with coronary vasospasm. Intensive medical treatment against coronary vasospasm is most important for prevention of VF recurrence, and the efficacy of implantable cardioverter-defibrillator (ICD) devices is controversial. We examined 19 consecutive patients with coronary spasm who had been successfully resuscitated from VF between 1993 and 2010, 13 of whom underwent ICD implantation. There were no apparent differences in the results of coronary angiography and acetylcholine provocation test or in medical therapy among them. Six patients underwent electrophysiological tests during the acetylcholine provocation test, and 3 of them showed ventricular arrhythmia. Three patients had recurrent VF under treatment with single calcium channel blocker (CCB), nitrates, and/or nicorandil. Two of them were without ICDs and were left in vegetative states, and the third was successfully resuscitated by an appropriate ICD discharge. The results of our study suggest that dual or multiple CCB treatment is preferable to prevent VF recurrence, and that combined treatment with ICD may be effective for some patients with coronary vasospasm who have been successfully resuscitated from VF. However, reasonable risk stratification for ICD implantation in these patients needs to be established in the future.
Takotsubo cardiomyopathy (TC) is a temporal dysfunction of the left ventricle (LV) due to psychological or physiological stress; however, it rarely causes LV thrombus. We report a case of a 49-year-old woman who developed LV thrombi due to TC despite anticoagulation therapy. The thrombi caused acute systemic infarction, with the most severe occlusion being in the right renal artery. The patient underwent percutaneous catheter aspiration thrombectomy of the right renal artery and her renal function recovered shortly after. The results of this case suggest that catheter aspiration thrombectomy is effective in the treatment of thromboembolism in TC.
Anticoagulation is recommended for the treatment of pulmonary embolism (PE) and deep vein thrombosis (DVT). In some cases, an inferior vena cava (IVC) filter is used to prevent PE. We report the case of a 70-yearold woman who developed non-massive PE and proximal DVT, which were treated using an IVC filter; two filters were placed owing to the fracture of the filters. Few previous reports have discussed IVC fractures and the difficulty in detecting such fractures on computed tomography before retrieval. Based on our experience, we suggest that a temporary IVC filter for DVT treatment should be considered carefully.
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