Metastatic Ovarian Granulosa Cell Tlimor
October 9th, 2014 by admin | Posted in Disease
A 67-year-old white woman presented to the emergency room of The Staten Island Hospital complaining of the sudden onset of dyspnea and right-sided chest discomfort. A chest radiograph revealed nearly complete collapse of the right lung, a right pulmonary nodule, and an estimated 30 percent left pneumothorax. Bilateral closed-tube thoracostomies was performed.
Her past medical history was significant for hypertension and hypercholesterolemia. The patient also had a history of a right ovarian granulosa cell tumor (stage IAii) for which she had undergone a total abdominal hysterectomy and bilateral salpingooopho-rectomy 17 years prior to this admission. Nine years prior to this admission, she had a workup for bilateral pulmonary nodules, which were believed to be benign. Four years later, she suffered a right spontaneous pneumothorax (15 percent) which was treated conservatively.
A CT scan of the chest, peformed shortly after admission, revealed multiple nodules of the right middle and lower lobes. A CT scan of the abdomen failed to demonstrate any signs of intra-abdominal disease. It is known that the size and pressure of esophageal varices, which correlate with risk of hemorrhage, parallel azygos blood flow. The volume of a compliant vessel increases Viagra Australia more easily, according to the formula of elastic pressure: C = AV/AP, where C = compliance, AV = volume change, and Ap = pressure change. According to the Hagen-Poisseulle equation in hydrokinetics (Q = AP ^r4/8 pL, where Q = flow velocity, r = the radius of a tube, Ap = the pressure gradient within the tube, and L = the length of the tube), when there is constant pressure in the portoesophageoazygos venous system, an increase in the cross-sectional area contributed by the azygos vein dilation decreases flow within the system. This in turn reduces the risk of variceal bleeding.
In addition to reducing the flow in the system overall, another factor may also be significant in preventing bleeding. In general, portal flow varies diurnally, with peak flow occurring at midnight. The azygos varix increases in size when the patient is recumbent, further reducing flow in the system. This phenomenon, as with the administration of propranolol at night, may play an important role in preventing variceal bleeding. The azygos varix thus may be present on chest radiograph before varices are diagnosed. In our patient, the mediastinal mass was seen 2 years before her first episode of variceal bleeding.