Wednesday, January 23, 2008

Double Take

It's the next day in the ER and you see the same case as the last one. This time, a 70 year old woman presents with dullness to percussion on her right lung fields, diminished breath sounds, decreased fremitus, and egophony. An upright chest X-ray shows blunted costophrenic angles and the lateral decubitus film looks the same as the one for the previous case.

This time though, the problem is compounded by abdominal distention. You appreciate a "fluid wave" - when you tap on one side of the belly, you generate a wave-like effect that transmits to the other side. The patient denies alcohol consumption. She reports a family history of ovarian cancer.

The treatment for this condition is surgery. Unfortunately, the patient does not survive surgery. An autopsy is done.

The pathology report has a big coffee stain on it. You can make out "bilateral...arose from ovarian stroma..."

Challenge: This syndrome is characterized by a triad of the lung finding, the abdominal finding, and the pathology finding. What is the syndrome called?

Related Questions:
1. What is the abdominal finding?
2. What is the pathology finding?

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1 comment:

Craig said...

Double Take

The patient presented with pleural effusion, ascites, and benign ovarian tumor, a triad of Meig's Syndrome. Meig's syndrome resolves after resection of the tumor. The pathology specimens show bilteral benign ovarian tumors. These are fibrothecomas that arise from the ovarian stroma.

Sources: Wikipedia, Health Sciences Library of University of Utah