A Case of Atypical Meig's Syndrome Presenting With Pleural and Pericardial Effusion

Meigs syndrome is a rare condition characterized by the triad of benign ovarian tumors, ascites, and pleural effusion. However, concurrent presentation with both pleural and pericardial effusions is exceedingly rare. This paper presents a unique case of Meigs syndrome in a 75-year-old African American female patient with a history of anemia who was admitted for a left femur fracture secondary to a fall.  In addition to her orthopedic injury, the patient exhibited intermittent abdominal fullness and discomfort, prompting a thorough diagnostic evaluation. Physical examination was unremarkable, and laboratory investigations revealed microcytic anemia with normal renal and hepatic function tests. Unexpectedly, imaging studies revealed the presence of a large lobulated enhancing mass lesion arising from the terminal ileum, with no evidence of ascites. Computed tomography (CT) imaging also revealed bilateral pleural effusions and a mild pericardial effusion. Initial diagnostic evaluations yielded no significant findings with normal CA-125 and CEA levels and no abnormalities in peripheral blood.  The pathophysiology underlying the development of pleural and pericardial effusions in Meigs syndrome remains unclear but is thought to involve lymphatic obstruction and increased vascular permeability secondary to the ovarian tumor.  In conclusion, this case underscores the importance of recognizing variant presentations of Meigs syndrome, particularly in the context of concurrent pleural and pericardial effusions, which may pose diagnostic challenges but warrant prompt identification and management to optimize patient outcomes.