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Assembly

Pleural Effusion Confusion

Author
Deepanjali Radhakrishnan Nair M.D, Department of Internal Medicine, University of Tennessee Health Science Center, Nashville
Bryan Hay M.D, Department of Internal Medicine, University of Tennessee Health Science Center, Nashville


Case

A 70-year-old female with a past medical history of asthma and hypothyroidism presented for evaluation of recurrent right sided pleural effusions for 3 months. She reported associated shortness of breath with exertion, dry cough, and an unintentional 20-pound weight loss over a period of 2 months. The patient underwent thoracentesis 3 times and pleural fluid analysis each time was consistent with an exudative effusion with mild leukocyte predominance. Pleural fluid flow cytometry, Acid Fast Bacilli (AFB), as well as bacterial and fungal cultures were negative. Her TSH was within normal limits. Due to recurrence of the effusion noted on CXR, a CT of chest, abdomen and pelvis was ordered (Figure 1 and Figure 2). Based on CT findings, she subsequently underwent hysterectomy and bilateral salpingo-oophorectomy. Biopsy of the bilateral ovarian masses showed ovarian fibroma.

Images

CT of chest, abdomen, and pelvis (Coronal Image)
CT of chest (axial image)

Question

What is the diagnosis?

A. Ovarian hyper stimulation syndrome
B. Meigs syndrome
C. Pseudo - Meigs syndrome
D. Luteinized thecoma

Answer