Acquired disorder associated with a triad presentation
of benign tumors of the ovary or other female pelvic organs, leading to
ascites and pleural effusion. Histologically, the benign ovarian tumor might
be a fibroma, thecoma, cystadenoma, or granulosa cell tumor.
In 1934, Salmon described the association of pleural
effusion with benign pelvic tumors. In 1936, Joe Vincent Meigs, an American
obstetrician, and John W. Cass, an American physician, described seven cases
of ovarian fibromas associated with ascites and pleural effusion.
In the United States, ovarian tumors are more prevalent
in upper socioeconomic groups. Ovarian fibroma is found in 2 to 5% of
surgically removed tumors and Meigs syndrome represents 1%. The
prevalence is unknown. It is seen from the third decade, with a peak in the
Meigs syndrome is characterized by the presence of
ascites and pleural effusion in the presence of a benign ovarian tumor.
Pseudo-Meigs syndrome presents in a similar fashion and is associated with
benign tumors of other pelvic organs. The cause of the ascites is uncertain
but may be a result of mechanical irritation of the peritoneum, venous or
lymphatic obstruction, or production of vasoactive substances by the tumor.
The development of pleural effusions, which are usually right sided and may
be massive, probably is caused by passage of ascitic fluid via
transdiaphragmatic lymphatics or directly via diaphragmatic defects.
Classically, the ascites and pleural effusions disappear following tumor
removal. Development of ascites may be caused by release of mediators (e.g.,
activated complements, histamines, fibrin degradation products) from the
tumor, leading to increased capillary permeability.
The presence of a pleural effusion and ascites in the
presence of a benign pelvic tumor and the disappearance of effusions
following excision of the tumor are a sine qua non in making the diagnosis.
Other causes of ascites and/or pleural effusions must be excluded. The
presence of elevated CA125 levels usually is suggestive of ovarian
malignancy. Elevated levels of CA125 have been reported in Meigs syndrome in
the absence of malignancy.
Meigs Syndrome: Usually presents as abdominal pain and/or distension. If the ascites is
significant or in the presence of a pleural effusion, dyspnea may be a
presenting feature. Nonproductive cough, malaise, and weight loss may
accompany the other clinical features.
Pseudo-Meigs Syndrome: Consists of pleural effusion, ascites, and benign tumors of the ovary other
than fibromas. These benign tumors include those of the fallopian tube or
uterus and mature teratomas, struma ovarii, and ovarian leiomyomas.
Atypical Meigs Syndrome: Characterized by a benign pelvic mass with right-sided pleural effusion but
without ascites. As in Meigs syndrome, pleural effusion resolves after
removal of the pelvic mass.
Respiratory status must be
evaluated. A recent chest radiograph is mandatory; if the pleural or
peritoneal fluid is interfering with respiratory mechanics, preoperative
drainage of the collections ...