Disorders of the Pleura |

Endometriosis as a Cause of Massive Ascites and Pleural Effusion FREE TO VIEW

David Chooljian*, MD; Jacqueline Ng, MD; Traci Murakami, MD; Tomio Miyai, MD; Chuan-Hsin Chang, MD; Jey Chung, MD; Eduardo Solbes, MD; Gerard Jenkins, MD; Wendy Wu, MD; Vibha Mohindra, MD; Eric Hsiao, MD; Allison Friedenberg, MD; John Wehner, MD; Weichia Chen, MD; Carl Kirsch, MD; Michael Nathanson, MD; Frank Kagawa, MD
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Stanford University School of Medicine, Palo Alto, CA

Chest. 2012;142(4_MeetingAbstracts):501A. doi:10.1378/chest.1389454
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SESSION TYPE: Pleural Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Endometriosis is a rare cause of pleural effusion and ascites. We present a case of endometriosis causing pleural effusion and ascites in a young nulliparous African-American woman.

CASE PRESENTATION: A 22-year-old African-American woman presented with six months of progressive abdominal distention and drainage from the umbilicus with intermittent cramping pain exacerbated by menses. Of note, she had an umbilical piercing removed one year previously due to intermittent pain and swelling which was also exacerbated during menses. She had decreased breath sounds and dullness to percussion throughout the right hemithorax. Induration and tenderness were noted at the umbilicus, with abdominal distention and a fluid wave. Chest radiography revealed diffuse right hemithorax opacification. Thoracentesis revealed a chocolate-colored exudative effusion; paracentesis showed similarly-colored ascites with a low serum albumin to ascites albumin gradient. Peritoneal fluid cytology only revealed numerous hemosiderin-laden macrophages. Serum tumor markers were notable for mild elevation in CA-125 (61 U/mL). While transvaginal ultrasound was normal, pelvic MRI did show a simple ovarian cyst and a hemorrhagic ovarian cyst, both <10cm. A well-circumscribed mass extending from the umbilicus to the peritoneum was also noted with biopsy demonstrating endometrial tissue. The patient was then started on ethinyl estradiol and norgestimate. Following drainage of the pleural effusion, pneumothorax ex vacuo was noted. Successful decortication was performed, with concurrent talc pleurodesis. Pleural biopsies revealed endometrial implants, as confirmed by immunochemical staining.

DISCUSSION: We found 64 cases in the literature of endometriosis presenting with ascites and/or pleural effusion. Where ethnicity and obstetric history were available, a majority of the patients were of African descent and nulliparous. Most effusions were right-sided. Where measured, CA-125 levels were >20U/mL. The presence of an umbilical endometrioma, and the need for decortication of a trapped lung, have both been described in association with this presentation. Medical treatment such as GnRH analogs generally leads to resolution of ascites, although the recurrence rate is high when treatment is stopped.

CONCLUSIONS: While endometriosis is a rare cause of ascites and pleural effusion, it has been described in the literature and is most common in nulliparous women of African descent. Endometriosis should therefore be considered as a cause of ascites and pleural effusion, particularly in this patient population.

1) Bhojawala J, et al. Endometriosis presenting as bloody pleural effusion and ascites-report of a case and review of the literature. Arch Gynecology Obstet. 2000 Jul; 264(1):39-41.

2) Gungor T, et al. A systematic review: endometriosis presenting with ascites. Arch Gynecology Obstet. 2011 Mar; 283(3):513-8.

DISCLOSURE: The following authors have nothing to disclose: David Chooljian, Jacqueline Ng, Traci Murakami, Tomio Miyai, Chuan-Hsin Chang, Jey Chung, Eduardo Solbes, Gerard Jenkins, Wendy Wu, Vibha Mohindra, Eric Hsiao, Allison Friedenberg, John Wehner, Weichia Chen, Carl Kirsch, Michael Nathanson, Frank Kagawa

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Stanford University School of Medicine, Palo Alto, CA




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