Journal of the Chinese Medical Association
Volume 69, Issue 1 , Pages 42-46, January 2006

Endometriosis Associated with Hemothorax

  • Hung-Tsung Lee

      Affiliations

    • Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
    • ,
  • Hong-Chung Wang

      Affiliations

    • Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr. Hong-Chung Wang, Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan, R.O.C.
    • ,
  • Ia-Tang Huang

      Affiliations

    • Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
    • ,
  • Huang-Chou Chang

      Affiliations

    • Division of Thoracic Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
    • ,
  • Jau-Yeong Lu

      Affiliations

    • Division of Chest MedicineDepartment of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan, R.O.C.

Received 3 January 2005; accepted 10 August 2005.

Article Outline

Bloody pleural effusion is rarely associated with endometriosis. To effectively treat this condition, it is important to differentiate the malady from other common diseases such as malignancy or tuberculosis. We describe the case of a 40-year-old multiparous female featuring right-sided hemothorax presenting with right shoulder pain and progressive shortness of breath for the preceding 2 months. Thoracoscopy disclosed grossly negative findings apart from multiple small pores in the right hemi-diaphragm with blood clots within them. Examination of the thoracoscopic biopsy specimens showed chronic pleuritis without evidence of malignancy or tuberculosis. Pelvic endometriosis was considered a possible diagnosis according to the results of abdominal computed tomography (CT) scan, transvaginal sonography, and the results of dilatation and curettage. Periodic episodes of symptoms concurrent with menstruation led to the suspicion of a relationship between these conditions in our patient. Despite the patient undergoing an abdominal total hysterectomy and adhesiolysis without salpingo-oophorectomy, recurrent right-sided bloody pleural effusion developed 1.5 months subsequent to surgery. As a consequence, danazol (400 mg/day) was maintained because of the endometriosis associated with pleural effusion. One year of regular follow-up later, there was no evidence of recurrent pleural effusion. We considered that the bloody pleural fluid arose via seepage from the pelvic endometriosis through the pores of the right hemi-diaphragm during menstruation.

Key Words:  endometriosis , hemothorax , pleural effusion , thoracoscopy

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Brews A . Endometriosis including endometriosis of the diaphragm and Megs' syndrome . Proc R Soc Med . 1954;47:461
  2. Shek Y , Lia JD , Pattillo RA . Endometriosis with a pleural effusion and ascites: report of a case treated with nafarelin acetate . J Reprod Med . 1995;40:540–542
  3. Bhojawala J , Heller DS , Cracchiolo B , Sama J . Endometriosis presenting as bloody pleural effusion and ascites: report of a case and review of the literature . Arch Gynecol Obstet . 2000;264:39–41
  4. Flanagan KL , Barnes NC . Pleural fluid accumulation due to intra-abdominal endometriosis: a case report and review of the literature . Thorax . 1996;51:1062–1063
  5. Wilkins SB , Thomson JB , Tyras DH . Hemothorax associated with endometriosis . J Thorac Cardiovasc Surg . 1985;89:636–638
  6. Olive DB , Schwartz LB . Endometriosis . N Engl J Med . 1993;328:1759–1769
  7. Mittal BR , Maini A , Das BK . Peritoneopleural communication associated with cirrhotic ascites: scintigraphic demonstration . Abdom Imaging . 1996;21:69–70
  8. Schuster DM , Mukundan S , Small W , Fajman WA . The use of the diagnostic radionuclide ascites scan to facilitate treatment decisions for hepatic hydrothorax . Clin Nucl Med . 1998;23:16–18
  9. Ripstein CB , Rohman M , Wallach JB . Endometriosis involving the pleura . J Thorac Surg . 1959;37:464–471
  10. Mentes BB , Kayhan B , Gorgul A , Unal S . Hepatic hydrothorax in the absence of ascites: report of two cases and review of the mechanism . Dig Dis Sci . 1997;42:781–788
  11. Daly JJ , Potts JM , Gordon L , Buse MG . Scintigraphic diagnosis of peritoneo-pleural communication in the absence of ascites . Clin Nucl Med . 1994;19:892–894
  12. Myers TJ , Arena B , Granai CO . Pelvic endometriosis mimicking advanced ovarian cancer: presentation with pleural effusion, ascites, and elevated serum CA 125 level . Am J Obstet Gynecol . 1995;173:966–967
  13. Yucel AE , Calguneri M , Ruacan S . False positive pleural biopsy and high CA125 levels in serum and pleural effusion in systemic lupus erythematosus . Clin Rheum . 1996;15:295–297
  14. Mouroux J , Perrin C , Venissac N , Blaive B , Richelme H . Management of pleural effusion of cirrhotic origin . Chest . 1996;109:1093–1096

PII: S1726-4901(09)70110-8

doi:10.1016/S1726-4901(09)70110-8

Journal of the Chinese Medical Association
Volume 69, Issue 1 , Pages 42-46, January 2006

Article Tools