Fictitious pseudo Meig’s syndrome: A medical emergency

The present case scenario deals with an acute on chronic symptomatology, and collapsed state of the patient with poor vitals on admission in casualty. Clinical work up pointing to an elevated serum CA 125 levels and USG pelvis suggesting peritoneal adhesions with cystic to firm mass in left ovary and minimal free fluid in abdomen and cul de sac, X Ray chest suggesting right sided Pleural effusion. It was after careful evaluation of the case, with past and present history along with signs, symptommatology and intraoperative findings that differentials like Chronic granulomatous lesions, endometriosis, Neoplastic lesions with metastasis and Meig’s syndrome or Pseudo Meig’s were evaluated. Finally, a diagnosis of genital tuberculosis with enodmetriosis was confirmed on histopathological evaluation. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5975 JCMSN 2011; 7(1): 57-64

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Pericardial Tamponade and Elevated Serum CA-125 Level in Inadequately Treated Hypothyroidism

Case Reports in Cardiology ◽

10.1155/2021/2666601 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Moaaz Baghal ◽

Viralkumar Amrutiya ◽

Bhoomi Patel ◽

Rutwik Patel ◽

Jonathan Hernandez ◽

...

Keyword(s):

Cardiac Tamponade ◽

Elevated Serum ◽

Abdominal Distension ◽

Young Female ◽

Pericardial Tamponade ◽

Medical Emergency ◽

Ca 125 ◽

Pericardial Window ◽

Abdominal Paracentesis ◽

Shed Light

Cardiac tamponade is a medical emergency and must be managed promptly, and reaching a diagnosis is imperative to prevent recurrence. Herein, we present a case of a young female patient that presented with progressive shortness of breath and abdominal distension and was found to have cardiac tamponade with the finding of elevation of a blood tumor marker, CA-125, in the setting of nonadherence to thyroid replacement therapy. She was managed by surgical pericardial window and abdominal paracentesis, with replacement of thyroid hormones leading to resolution of the tamponade and ascites. CA-125 elevation associated with cardiac tamponade and myxedema ascites due to hypothyroidism is very rare, and we aim to shed light on the importance of having a broad differential when approaching cardiac tamponade and understand the association between CA-125 and hypothyroidism.

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A Case Study of a Large and Rare Pleomorphic Liposarcoma in The Chest Area

Journal of Internal Medicine and Emergency Research ◽

10.37191/mapsci-2582-7367-1(2)-010 ◽

2020 ◽

Author(s):

Yuanjun Cheng

Keyword(s):

Delayed Diagnosis ◽

Clinical Work ◽

Radical Excision ◽

Pathological Findings ◽

Chest Tightness ◽

Pleomorphic Liposarcoma ◽

Left Chest ◽

Specific Symptoms ◽

Work Up

Pleomorphic liposarcoma rarely develops in the chest area. This report presents a primary pleomorphic liposarcoma that was discovered in the left chest area of a 74-year-old female patient. The patient had presented specific symptoms, including cough, chest tightness and shortness of breath. A radical excision of the tumor was performed. The tumor was extremely large (27 cm - 24 cm- 10 cm) and completely encapsulated. Upon histological examination, it was diagnosed as a giant, pleomorphic liposarcoma. Thereafter, non-specific radiological and endoscopic results during clinical work-up delayed diagnosis until post-operative histology were gathered. In this report, the case-specific clinical and radiological diagnostic challenges are discussed, as well as the relevant surgical and pathological findings.

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The Applications of Artificial Intelligence in Chest Imaging of COVID-19 Patients: A Literature Review

Diagnostics ◽

10.3390/diagnostics11081317 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1317

Author(s):

Maria Elena Laino ◽

Angela Ammirabile ◽

Alessandro Posa ◽

Pierandrea Cancian ◽

Sherif Shalaby ◽

...

Keyword(s):

Artificial Intelligence ◽

Literature Review ◽

Diagnostic Imaging ◽

Clinical Work ◽

Rapid Expansion ◽

Chest Imaging ◽

Imaging Data ◽

Prognostic Information ◽

Quantitative Ct ◽

Work Up

Diagnostic imaging is regarded as fundamental in the clinical work-up of patients with a suspected or confirmed COVID-19 infection. Recent progress has been made in diagnostic imaging with the integration of artificial intelligence (AI) and machine learning (ML) algorisms leading to an increase in the accuracy of exam interpretation and to the extraction of prognostic information useful in the decision-making process. Considering the ever expanding imaging data generated amid this pandemic, COVID-19 has catalyzed the rapid expansion in the application of AI to combat disease. In this context, many recent studies have explored the role of AI in each of the presumed applications for COVID-19 infection chest imaging, suggesting that implementing AI applications for chest imaging can be a great asset for fast and precise disease screening, identification and characterization. However, various biases should be overcome in the development of further ML-based algorithms to give them sufficient robustness and reproducibility for their integration into clinical practice. As a result, in this literature review, we will focus on the application of AI in chest imaging, in particular, deep learning, radiomics and advanced imaging as quantitative CT.

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Use of CA-125 to Define Progression of Ovarian Cancer in Patients With Persistently Elevated Levels

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.20.4054 ◽

2001 ◽

Vol 19 (20) ◽

pp. 4054-4057 ◽

Cited By ~ 139

Author(s):

Gordon J.S. Rustin ◽

Maria Marples ◽

Ann E. Nelstrop ◽

Mohamed Mahmoudi ◽

Tim Meyer

Keyword(s):

Ovarian Cancer ◽

Clinical Trials ◽

Myocardial Infarct ◽

Elevated Serum ◽

Epithelial Ovarian Carcinoma ◽

Ca 125 ◽

Clinical Progression ◽

False Positive Prediction ◽

Upper Limit ◽

Accurate Definition

PURPOSE: To determine an accurate definition for progression of ovarian cancer in patients with a persistently elevated serum CA-125. PATIENTS AND METHODS: A retrospective analysis was performed on 300 patients with epithelial ovarian carcinoma with at least one measurement of CA-125. The date of progression according to clinical or radiologic criteria was ascertained in the 88 patients with persistently elevated CA-125 levels (> 23 U/mL). This was compared with the date of progression according to CA-125, defined as the date on which the CA-125 level first increased to ≥ twice its nadir level, confirmed by a second sample also ≥ twice the nadir. RESULTS: Eighty of the 88 patients had evidence of progression by both standard and CA-125 criteria, giving a sensitivity of 94%. In six of these patients, no sample was taken to confirm CA-125 doubling. In 13 patients, CA-125 doubling occurred after the date of clinical progression. Only one patient had a false-positive prediction of progression according to CA-125; the patient died as a result of a myocardial infarct before evidence of clinical progression. CONCLUSION: In patients whose CA-125 level decreases to normal after chemotherapy, a doubling from the upper limit of normal has been shown to predict progression. In those with persistently elevated levels, doubling of CA-125 from its nadir level has now been shown to accurately define progression. If confirmed, these CA-125 criteria should be used as additional end points in clinical trials.

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A Case of Bronchiectasis with Elevated Serum CA 125 Level

Tuberculosis and Respiratory Diseases ◽

10.4046/trd.2009.66.6.467 ◽

2009 ◽

Vol 66 (6) ◽

pp. 467

Author(s):

Bong Chul Shin ◽

Tae Hyoung Koo ◽

Sang Ock Kim ◽

Hsing Chien Ter ◽

Soo Jung Um ◽

...

Keyword(s):

Elevated Serum ◽

Ca 125

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Meigs' syndrome with elevated CA 125: case report

Sao Paulo Medical Journal ◽

10.1590/s1516-31802003000500007 ◽

2003 ◽

Vol 121 (5) ◽

pp. 210-212 ◽

Cited By ~ 10

Author(s):

Sabas Carlos Vieira ◽

Leonardo Halley Carvalho Pimentel ◽

José Carlos Castelo Branco Ribeiro ◽

Argemiro Ferreira de Andrade Neto ◽

Jerúsia Oliveira Ibiapina de Santana

Keyword(s):

Case Report ◽

Pleural Effusion ◽

Ovarian Tumor ◽

Frozen Section ◽

Transvaginal Ultrasound ◽

Elevated Serum ◽

Ca 125 ◽

Brazilian Woman ◽

Thoracic Drainage ◽

Benign Ovarian Tumor

CONTEXT: Meigs' syndrome consists of a benign ovarian tumor accompanied by ascites and hydrothorax. Elevated serum CA 125 levels in postmenopausal women with solid adnexal masses, ascites and pleural effusion are highly suggestive for malignant ovarian tumor. However, patients with Meigs' syndrome can also have elevated serum CA 125 levels. The authors report a case of Meigs' syndrome with elevated CA 125 level. OBJECTIVE: This is a case report of Meigs' syndrome with elevated CA 125 level. CASE REPORT: A 65-year-old Brazilian woman had presented progressive dyspnea, weight loss and decline in general condition over the 7 months preceding admission to our service. In another hospital, the patient had been submitted to thoracic drainage due to pleural effusion. With recurrence of the pleural effusion and increase in abdominal volume due to ascites and a pelvic mass, the patient sought our service. Transvaginal ultrasound showed an extensive adnexal solid mass of 16.4 x 10.8 cm located in the pelvis without exact limits, and the serum CA 125 level was elevated. With a preoperative diagnosis of ovarian carcinoma, the patient was submitted to exploratory laparotomy, which revealed a left ovarian tumor. The frozen section diagnosis was thecoma. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The histology of the specimen confirmed the diagnosis of thecoma. The patient was asymptomatic with a normal serum CA 125 level 20 months after the operation.

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Combinations of Symptoms in Emergency Presentations: Prevalence and Outcome

Journal of Clinical Medicine ◽

10.3390/jcm8030345 ◽

2019 ◽

Vol 8 (3) ◽

pp. 345 ◽

Cited By ~ 5

Author(s):

Tobias Kuster ◽

Christian Nickel ◽

Mirjam Jenny ◽

Lana Blaschke ◽

Roland Bingisser

Keyword(s):

Time Course ◽

Predictive Power ◽

Secondary Analysis ◽

Clinical Work ◽

Adverse Outcomes ◽

University Hospital ◽

Chief Complaints ◽

The University ◽

Work Up ◽

Inclusion Period

The predictive power of certain symptoms, such as dyspnoea, is well known. However, research is limited to the investigation of single chief complaints. This is in contrast to patients in the emergency department (ED) presenting usually more than one symptom. We aimed to identify the most common combinations of symptoms and to report their related outcomes: hospitalisation, admission to intensive care units, and mortality. This is a secondary analysis of a consecutive sample of all patients presenting to the ED of the University Hospital Basel over a total time course of 6 weeks. The presence of 35 predefined symptoms was systematically assessed upon presentation. A total of 3960 emergency patients (median age 51, 51.7% male) were included. Over 130 combinations of two, 80 combinations of three, and 10 combinations of four symptoms occurred 42 times or more during a total inclusion period of 42 days. Two combinations of two symptoms were predictive for in-hospital mortality: weakness and fatigue (Odds ratio (OR) = 2.45), and weakness and headache (OR = 3.01). Combinations of symptoms were frequent. Nonspecific complaints (NSCs), such as weakness and fatigue, are among the most frequently reported combinations of symptoms, and are associated with adverse outcomes. Systematically assessing symptoms may add valuable information for prognosis and may therefore influence triage, clinical work-up, and disposition.

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Clinical Work-Up For Renovascular Hypertension

Urologic Clinics of North America ◽

10.1016/s0094-0143(21)01079-x ◽

1975 ◽

Vol 2 (2) ◽

pp. 301-310

Author(s):

Stanley S. Franklin ◽

Morton H. Maxwell

Keyword(s):

Renovascular Hypertension ◽

Clinical Work ◽

Work Up

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Clinical Implications of CA 125 Elevation in Patients with Cardiac Amyloidosis: An Observational Study

10.21203/rs.3.rs-202184/v1 ◽

2021 ◽

Author(s):

Muzheng Li ◽

Zhijian Wu ◽

Ilyas Tudahun ◽

Qiuzhen Lin ◽

Na Liu ◽

...

Keyword(s):

Overall Survival ◽

Cardiac Troponin ◽

Cardiac Amyloidosis ◽

Troponin T ◽

Elevated Serum ◽

Common Finding ◽

Ca 125 ◽

Control Group ◽

Clinical Implications ◽

Cardiac Troponin T

Abstract Aims: The level of serum carbohydrate antigen 125 (CA 125) elevated is a common finding in patients with cardiac amyloidosis in clinical practice. It is unclear whether CA 125 is correlated with cardiac amyloidosis. The aim of this study was to systematically evaluate the clinical implications of CA 125 elevation in patients with cardiac amyloidosis.Methods and Results: We enrolled 101 patients diagnosed with cardiac amyloidosis at the Second Xiangya Hospital, 41 patients with acute decompensated heart failure (AHF) and 39 patients with multiple myeloma (MM) who were confirmed to have no cardiac amyloidosis served as control group, respectively. In 101 patients with cardiac amyloidosis, 58 (57%) patients had elevated serum CA 125 levels, which the mean age was 61.2 ± 11.4 years. Patients with high CA 125 were more likely to present with polyserositis ( 79.3% vs 60.5%, p = 0.03) , higher levels of hemoglobin (117.22 ± 21.87 g/L vs. 106.07 ± 25.15 g/L, p = 0.01), serum potassium (4.17 ± 0.49 mmol/L vs. 3.98 ± 0.41 mmol/L, p = 0.05), low density lipoprotein-cholesterol (2.98 ± 1.65 mmol/L vs. 2.22 ± 1.10 mmol/L, p = 0.01), and cardiac troponin T (115 pg/mL vs. 59.52 pg/mL, p = 0.005) . The serum CA 125 levels were significantly higher in cardiac amyloidosis than AHF and MM. The median overall survival for patients with elevated and normal serum CA125 were 5 and 20 months, respectively (p = 0.012). According to multivariate Cox hazard analysis, CA 125 (HR 1.002, 95%CI 1.000-1.004, p = 0.020) contributed to all-cause mortality. The time-dependent receiver operating characteristic was used to reflect the accuracy of different biomarkers in predicting overall survival at various time points by the area under the curve (AUC). CA 125 has no worse prediction accuracy than cardiac troponin T, NT-proBNP and LDH according to the AUC.Conclusions: The prevalence of elevated serum CA 125 levels is more than 50% in patients with cardiac amyloidosis. As an independent prognostic predictor, highly serum CA 125 values indicated the lower overall survival and the accuracy of predicting prognosis was not inferior to the other biomarkers.

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