A46-09 Tension Hydrothorax With Malignant Cytology Leading to the Diagnosis of Ovarian Carcinoma

Hydrothorax is an uncommon initial first presentation of ovarian cancer. We describe a case of malignant tension hydrothorax that led to the diagnosis of stage IVA high-grade serous ovarian carcinoma.A 74-year-old woman with hypertension and poorly controlled diabetes presented with acute dyspnea, pleuritic chest pain, and hypoxemia. Chest radiograph revealed complete opacification of the right hemithorax with mediastinal shift to the left, suggesting a large pleural effusion. Emergent chest-tube decompression produced immediate clinical improvement. Computed tomography of the chest showed dense right-lung consolidation and a large pleural effusion; incidentally, a > 12 cm complex pelvic mass was identified. Pleural-fluid cytology was positive for malignant cells.Subsequent MRI of the abdomen and pelvis confirmed a cystic ovarian mass with solid components. The patient underwent exploratory laparotomy with primary debulking; frozen and final pathology revealed high-grade serous carcinoma involving the ovary and fallopian tube with peritoneal implants, consistent with FIGO stage IVA disease. Her course was complicated by persistent pleural drainage requiring a tunneled pleural catheter. Gynecologic oncology initiated systemic chemotherapy with carboplatin, paclitaxel, and bevacizumab.Malignant pleural effusion is a recognized manifestation of ovarian cancer, but malignant tension hydrothorax secondary to ovarian cancer is exceedingly rare. The mechanism may involve pleural metastases or diaphragmatic lymphatic obstruction. This case emphasizes the importance of considering gynecologic malignancy in elderly women with unexplained pleural effusions and highlights the need for early multidisciplinary collaboration between pulmonary, and gynecologic-oncology teams. A. Chest radiograph showing complete opacification of the right hemithorax consistent with large effusion and mediastinal shift. B. Coronal CT abdomen and pelvis demonstrating a complex cystic pelvic mass consistent with ovarian carcinoma. This abstract is funded by: None