－S 194 －
￭ S-263 ￭
Hypothyroidism Masquerading as Ovarian Malignancy: A Case Report
메리놀병원
*지준형, 김성만, 김동준, 김유정, 송여정, 천민구, 조경임, 이현국, 김태익
We report a 44-year-old woman with massive ascites, elevated serum carbohydrate antigen 125 (CA 125) concentrations (118 U/mL), pericardial effusion, and junctional bradycardia (Fig. 1). Ascites caused by hypothyroidism is rare and the pathogenesis is unclear. The ascitic fluid showed elevated total protein concentration and a high serum-ascites albumin gradient. The massive ascites and increased serum, ascitic, and pericardial CA 125 concentrations, led us to make the incorrect presumptive diagnosis of ovarian malignancy with metastasis. However, gastroscopy, colonoscopy, transvaginal ultrasonography gave normal results, and there was no evidence of malignancy through PET-CT (positron emission tomography-computed tomography) except elevated level of CA 125. To confirm the diagnosis, she had a diagnostic abdominal laparoscopic biopsy, which showed no evidence of intraperitoneal malignancy. Not only ascites, junctional escape rhythm with marked bradycardia is very rare feature of hypothyroidism as well. Following thyroid hormone replacement, the ascites and serum CA 125 gradually decreased (94 U/mL) and the heart rhythm was returned to sinus bradycardia. This is the first case report of complicated hypothyroidism as far as we know. Thyroid function should be checked in all patients with ascites and raised CA 125 concentrations.
￭ S-264 ￭
A Case of vegetation on permanent pacemaker lead and open intracardiac removal and implantation of a permanent epicardial pacing
Eulji University Hospital
*Kim Ki-Bang, Kim Jeong-Hee, Kim Dong-Pil
A 78-year-old woman with a history of implantation of a VVIR permanent pacemaker as a result of AV-complete block three years ago presented to our clinic with febrile sence, chilling, myalgia, chest discomfort, and syncope (for 5 minutes). Her symptoms had started seven days ago. When the patient presented to our clinic, Physical examination revealed a temperature of 36.5°C. There were no cardiac murmurs or extra heart sounds. No stigmata of infectious endocarditis were observed. The remainder of the physical examination was unremarkable.
Laboratory data included white blood cell count of 21.55×109/l and C-reactive protein concentration of 12.1 mg/dl. Pacemaker dysfunction was not detected by electrocardiogram. Transthoracic echocardiography revealed multiple vegetations on the tricuspid valve (15×8 and 11×7 mm) and pacemaker lead . Blood cultures were positive (Staphylococcus aureus). Fever was not controlled with antibiotics (vancomycin and gentamycin). The patient was referred to a surgical team because of enlargemnet of vegetations two weeks later. Vegetations on the tricuspid valve were removed and pacemaker leads were excised. The patient underwent implantation of a permanent epicardial pacing wire in diaphragmatic surface of right ventricle and a generator in upper rectus sheath. Therapy with antibiotics had been continued for 4 more weeks postoperatively. Outpatient follow-up was carried out by Cardiology department and no further problems were recorded
