Lost in effusion

摘要

In February, 2010, a 45-year-old woman weighing 220 kg (body-mass index 68 kg/m) was referred to our institution after a 3-month history of progressive abdominal distension without fever or night sweats or other complaints (appendix). Medical and family history was otherwise unremarkable, with her last gynaecological examination 2 years previously. Sonography of the abdomen showed ascites but no other pathological changes. Repeated paracenteses drained 32 L of serous, exudative fluid over 16 days. Cytology detected papillary formation of epithelial cells with psammoma bodies suggestive of a serous tumour of the ovaries. Sonography of the pelvis and abdomen and open field MRI (patient's weight and circumference precluded CT) showed large bilateral cystic pelvic tumours, abundant ascites, but no further pathological changes in the abdomen (figure A). Blood tests were normal except for a raised CA125 of 967 kU/L (normal range, 0-35).