A 61-year-old woman is evaluated for progressive abdominal distension and right-sided breathlessness. CT shows a solid pelvic mass, moderate ascites, and a right pleural effusion that is cytologically bland and negative for malignant cells. Serum CA-125 is 85 U/mL. What is the most likely diagnosis?

• A Ovarian carcinoma with peritoneal metastases
• B Tuberculous peritonitis with sympathetic effusion
• C Ovarian fibroma causing Meigs syndrome ✓
• D Congestive cardiac failure with hepatic capsular pseudolesion

Explanation

Meigs syndrome is the triad of a benign ovarian fibroma, ascites, and pleural effusion (usually right-sided), and both fluid collections resolve completely after tumour resection. CA-125 can rise substantially in Meigs syndrome due to peritoneal irritation, which falsely suggests malignancy; the cytology-negative effusion and benign imaging features of the mass favour fibroma. Tuberculous peritonitis would typically show lymphocytic ascites with adnexal thickening rather than a discrete solid fibroid.

Reference: Fishman's Pulmonary Diseases and Disorders, 5th ed.

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