Abstract Introduction Pseudo-Meigs’ syndrome is defined as the triad of a gynecologic tumor other than ovarian fibroma, pleural effusion and ascites which resolves after tumor removal.1 The proposed pathogenic mechanism is peritoneal irritation or fluid secretion from the pelvic tumor with transdiaphragmatic migration of fluid into the pleural space.1 Rarely, sudden death due to respiratory compromise has been reported.2 Here we describe the case of a patient who rapidly developed a complicated pleural effusion and respiratory failure in the setting of infected leiomyoma. Clinical case A 46 year-old female with past medical history of iron-deficiency anemia and uterine fibroids presented to the hospital for lower abdominal pain. She was ill-appearing with abdominal tenderness and tachycardia. Labs were significant for mild leukocytosis. Computer-tomography scan of the abdomen/pelvis revealed a 14.5x 17.2 x 16.7cm heterogenous mass containing solid and cystic components arising from the posterior uterus, moderate ascites and small right pleural effusion. She was admitted for pain control and work up of uterine mass. Two days later, she developed hypoxic respiratory failure requiring intensive care monitoring. Computer-tomography of the chest showed a large right pleural effusion with adjacent atelectasis. Leukocytosis worsened and antibiotics were started. Pseudo-Meigs’ syndrome and uterine infection were assumed and a chest tube was placed. Pleural fluid analysis was consistent with exudative effusion. The next day she underwent total abdominal hysterectomy with bilateral salpingectomy. Pathology of the abdominal mass showed leiomyoma and a cyst with features of endometriosis. Tissue cultures grew Streptococcus agalactiae. Blood cultures from admission and pleural cultures remained negative. Her post-operative course was without abdominal complications and the pleural effusion resolved within a week. Discussion Though usually benign, Pseudo-Meigs’ syndrome can have detrimental consequences when left untreated. Few instances of rapidly accumulating pleural effusions have been documented in this clinical context.3 This case describes a patient who quickly developed respiratory failure in the setting of Pseudo-Meigs’ syndrome caused by large, infected leiomyoma. Her hospital course highlights the need for close monitoring of patients with large abdominal mass and aggressive management in those developing signs of respiratory failure. Citations 1. Saha, S., & Robertson, M.(2012). Meigs’ and pseudo-Meigs’ syndrome. Australasian journal of ultrasound in medicine, 15(1), 29-31. 2. Gitto, L.(2025). An exceptional case of sudden death due to pseudo-Meigs syndrome. Journal of Forensic Sciences. 3. Hahm, TS., Ham, JS., & Kang, JY.(2010). Unilateral massive hydrothorax in a gynecologic patient with pseudo-Meigs’ syndrome-A case report. Korean Journal of Anesthesiology, 58(2), 202-206. This abstract is funded by: None
Mittag et al. (Fri,) studied this question.