Covert

A 56 year old woman presents with worsening dyspnea and abdominal distention for 8 months.

Her medical history is unremarkable, while her menopause took place at 52 years of age. She has had 3 uneventful pregnancies.

A full blood count and chest x-ray show a hemoglobin level of 13 g/dl and a right sided pleural effusion respectively. A recent mammogram was normal.

Select Relevant Investigations
Ultrasound abdomen/pelvis

Performed

There is a large hypoechogenic homogenous mass (10x9 cm) arising from the right ovary. The uterus and left ovary appear normal. There is moderate ascites. No liver metastases or intra-abdominal lymphadenopathy is seen.
CA-125

Performed

The CA-125 level is 50 U/ml (normal: < 35)
Pleural tap

Performed

Protein: 1.7 g/dl (s. protein: 6 g/dl)
LDH: 30 IU/l (s. LDH: 100 IU/l)
Gram & Ziehl-Neelson stains: negative
Microscopy: Reactive mesothelial cells
Quantiferon test: negative
ADA: 28 IU/L (normal: < 40)
Upper + Lower GI endoscopy

Performed

No abnormalities are noted

Select Relevant Management
Exploratory laparotomy
Antituberculous therapy
Steroids
Chest drain