JS is a 48-year-old female who presented to a local ED with complaints of worsening dyspnea on exertion and the inability to "catch her breath." For the past 24 hours, she has experienced shortness of breath at rest. She also reports some mild abdominal bloating (especially after meals), early satiety, and increased flatus. She has attributed this to her history of irritable bowel syndrome (IBS), which is managed by her primary care physician.
Upon presentation to the ED, her vital signs were:
Heart rate: 120
Blood pressure: 135/72
Sp02: 88 percent on room air
She was placed on two liters of oxygen via nasal cannula, and her SpO2 increased to 100 percent.
Her past medical history includes hypertension, asthma, IBS, and hypothyroidism. JS also has a surgical history consisting of an appendectomy as a child and a bilateral oophorectomy for benign ovarian cysts at the age of 42.
Family medical history:
- Mother: Hypertension, diabetes, renal failure
- Father: Lung cancer
- Sister: Ovarian cancer, IBS
She underwent a chest X-ray that revealed a large right-sided pleural effusion, but based on the above information, additional information is necessary.
Since additional clinical information is needed to diagnose the patient, a CT of the chest has been ordered. It confirmed the diagnosis, but an additional abnormality was also noted in the upper abdominal area, which is concerning for malignancy. A CT of the abdomen and pelvis revealed omental caking and lymphadenopathy. Tumor markers revealed an elevation in her CA125 with a level of over 2,000. She underwent a pleuracentesis, which revealed metastatic carcinoma of Mullerian primary.