Re: Postmenopausal pelvic free fluid
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Wed May 9 21:28:49 2007
Only 49y6months but possess that tool, albeit a rusty one.
Garry :)
At Wed, 09 May 2007, Andrew Folley wrote:
>
>Culdecentesis is a wonderful tool that anyone 50 and over will still have in
>their armamentarium.
>
>>From: garrys@mindspring.com (Garry E. Siegel, M.D.)
>>Reply-To: ob-gyn-l@obgyn.net
>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>Subject: Re: Postmenopausal pelvic free fluid
>>Date: Tue, 8 May 2007 20:57:18 -0500
>>
>>Culdocentesis?
>>
>>When is the last time anybody did one of those?
>>
>>I think that the likelihood that she has something bad is low.
>>
>>Another case:
>>
>>85 YO P1001 in the hospital from assisted living for
>>"dwindles"--abnormal Na+, etc. She is spry but a bit confused.
>>
>>Renal ultrasound saw a bit of fluid in the endometrial cavity.
>>Pelvic ultrasound, transabdominal, saw the same. She was too honery for
>>a transvaginal scan.
>>Her exam was normal (hospital bed), and I sent a pap.
>>
>>Any thoughts?
>>
>>Garry
>>
>>PS--has had midline laparotomy years ago for something--patient and
>>daughter simply don't know, but the daughter thinks that she only has
>>1/2 of one ovary. She is not bleeding, and is NED for some type of
>>bladder cancer.
>>
>>Garry
>>
>>At Tue, 08 May 2007, Andrew Folley wrote:
>> >
>> >I am not certain what the significance of peritoneal fluid would be in
>>this
>> >lady??? I would be inclined to wait and watch recheck echo in 3 to 6
>>months
>> >or at most do an office culdecentesis looking at the fluid for cytololgy
>>and
>> >protein level etc. It seems like laparoscopy might be doing too much at
>>this
>> >point. agf
>> >
>> >>From: AllanHo@aol.com (Allan)
>> >>Reply-To: ob-gyn-l@obgyn.net
>> >>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>> >>Subject: Postmenopausal pelvic free fluid
>> >>Date: Tue, 8 May 2007 17:46:34 -0500
>> >>
>> >>What would you do?
>> >>
>> >>60 yo P3 menopausal since age 45. New patient to me 3 weeks ago with no
>> >>specific complaints. Had some left sided tenderness during bimanual
>> >>exam. Transvaginal ultrasound showed free fluid in cul de sac. (Uterus
>> >>was small. Ovaries were not seen.) Largest pocket 2x2x2cm. CBC, TSH,
>> >>CEA, CA125, Liver & renal function tests were all normal. Chest x ray,
>> >>CT abdominal & pelvis were non-contributory. Guaiacs were negative.
>> >>Colonoscopy was negative. Same amount of pelvic free fluid in CDS three
>> >>weeks later. Patient is asymptomatic.
>> >>
>> >>I am thinking about doing a culdocentesis, but also feel that going
>> >>directly to laparoscopy may yeild more information and avoid the
>> >>possibility of vaginal contamination of the fluid for culture. Thanks
>> >>in advance for your input.
>> >>
>> >>--
>> >>Allan
>> >>Solo practice
>> >>Southwest, PA
>> >
>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
|
|
