Disorders of the Pleura |

Tension Right Hydrothorax and Massive Ascites in a 48-Year-Old Woman After Hormonotherapy and Total Hysterectomy: Atypical Ovarian Hyperstimulation Syndrome FREE TO VIEW

Eleftheria Haini, MD; Andreas Afthinos, MD; Eleftherios Markatis, MD; Dimitra Haini, MD; Linos Tsilias, MD; Kostas Pagratis, MD; Ilias Papanikolaou, MD; Kyriakos Hainis, MD
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Corfu General Hospital, Corfu, Greece

Chest. 2014;145(3_MeetingAbstracts):260A. doi:10.1378/chest.1825714
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SESSION TITLE: Pleural Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: The controlled ovarian stimulation (COS) may cause Ovarian Hyperstimulation Syndrome (OHS). The severe OHS is characterized by ascites and pleural effusion, due to movement of fluid in the extravascular space. A case of a woman who developed a clinical picture similar to severe OHS after COS and total hysterectomy is presenting.

CASE PRESENTATION: A 48 years old woman, smoker, with a history of Brugada disease and defibrillator placement, presented to the Emergency Department (ED) with dyspnea and abdominal pain. Ten days ago the patient underwent total hysterectomy because of metrorrhagia due to fibroids. Seventy-five and forty-five days before surgery two injections of Triptorelin (Arvekap) 3.75mg were given. In the ED the patient was afebrile, with 30 breaths per minute, SpO2 86% (FIO2 21%), heart rate 105 beats/minute, arterial pressure 107/79 mmHg, dullness of the right hemi-thorax and diffuse abdominal distension. Chest x-ray and CT showed massive right pleural effusion without findings of pulmonary embolism. Abdominal Ultrasonography and CT described large amount of ascites and hysterectomy. The Echocardiogram was normal. Laboratory tests were remarkable for HCT 42.1%, HGB 14.3 gr/dl, urea 133 mg/dl, creatinine 2.7 mg/dl, Na 133 mEq/L. Pleural and ascites fluids were transudates. The patient was treated with drainage of pleural fluid through a small chest catheter and supportive care. A total of 5.6 lt of pleural fluid were drained. The ascites and pleural fluid were resolved by the 9th and 16th day, respectively. Two years later the patient is without ascites and pleural effusion.

DISCUSSION: The clinical picture is similar to the severe OHS. However, the OHS is excluded by definition. Whether the COS combined with surgery caused the release of vasoactive substances by the ovaries, prior to their surgical removal, remains a question.

CONCLUSIONS: This is the case of a woman who developed a clinical picture similar to severe OHS after COS and total hysterectomy. The etiology of this syndrome is not clear. The drainage of pleural fluid through a chest tube is the main therapeutic measure.

Reference #1: The Practice Committee of the American Society for Reproductive Medicine. 2006; Ovarian Hyperstimulation Syndrome. Fertility and Sterility 86, s178-s183.

Reference #2: Leon C. Bass, Caralee Forseen, and Thomas Dillard. Tension Hydrothorax as a Rare Presentation of Ovarian Hyperstimulation Syndrome Chest October 2010 138:4 MeetingAbstracts 29A;

DISCLOSURE: The following authors have nothing to disclose: Eleftheria Haini, Andreas Afthinos, Eleftherios Markatis, Dimitra Haini, Linos Tsilias, Kostas Pagratis, Ilias Papanikolaou, Kyriakos Hainis

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