Abstract Introduction Meigs syndrome, with reported prevalence of 1% in ovarian tumors and fibromas, refers to the triad of a benign ovarian tumor, ascites, and pleural effusion that resolves after tumor removal. However, when this occurs secondary to another type of tumor, such as a malignant ovarian neoplasm, it is referred to as pseudo-Meigs syndrome, with less than 100 reported cases in the literature. Both syndromes can represent a diagnostic challenge due to respiratory symptoms and exudative effusions mimicking infectious, thromboembolic, or malignant etiology. Case Presentation 53-year-old female with no prior medical history presented with one-month of persistent cough and dyspnea. She had been treated with outpatient amoxicillin for presumed pneumonia without significant improvement. On admission, laboratory evaluation revealed leukocytosis (14. 9 × 10⁹/L) with neutrophillic predominance, hemoglobin 11. 4 g/dL, elevated D-dimer level (16, 665 FEU/mL), and BNP 372 pg/mL. Infectious work-up, including sputum, viral PCR, and blood cultures were negative. Chest X-ray demonstrated a moderate right-sided pleural effusion. Due to concerns for Pulmonary Embolism, CTA chest was obtained revealing bilateral pulmonary emboli, a large right pleural effusion, and incompletely visualized abdominal ascites with peritoneal thickening. Doppler ultrasound showed an unprovoked left lower extremity DVT. Thoracentesis performed, drained 2, 000 mL of straw-colored exudative, lymphocytic fluid (protein 4. 7 g/dL, LDH 332 U/L) with negative cytology and culture, suspected to be secondary to PE. However, the effusion reaccumulated. Thorough physical examination revealed a firm, non-tender right-sided abdominal mass. Subsequent abdominal CT revealed a large 16-cm complex right adnexal mass with omental nodularity and moderate ascites, consistent with findings on abdominal ultrasound. Ovarian tumor markers, including CA-125 (1979 U/mL), CA19-9 (2375 U/mL), and HE4 (790 pmol/L), were elevated. Over one month, the patient underwent two subsequent thoracentesis and a paracentesis with consistently negative culture and cytology. CT-guided biopsy of the adnexal mass showed a Müllerian neoplasm consistent with endometrioid carcinoma, confirming pseudo-Meigs syndrome. Discussion Exudative pleural effusions, as defined by Light’s criteria are commonly due to infection, malignancy, or thromboembolic disease. Psuedo-Meigs syndrome remains a diagnostic challenge due to its rarity and repeatedly negative cytology despite recurrent effusions. Unlike metastatic pleural effusion, cytology remains negative as fluid accumulation results from transdiaphragmatic migration of ascitic fluid and tumor-mediated cytokine-induced capillary permeability rather than pleural invasion. Histopathologic confirmation of the ovarian lesion is essential for diagnosis. Early recognition is crucial, as surgical resection of tumor leads to complete and sustained resolution of ascites, pleural effusions, and respiratory symptoms. This abstract is funded by: None
Zubairi et al. (Fri,) studied this question.