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Disorders of the Pleura |

Ovarian Hyperstimulation Syndrome: A Rare Cause of Unilateral Pleural Effusion FREE TO VIEW

Ali Sami Gurbuz, MD; Mustafa Calik, MD; Emel Ebru Ozcimen, MD; Necati Ozcimen, MD; Saniye Calik, MD
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Konya Education and Research Hospital, Konya, Turkey


Chest. 2015;148(4_MeetingAbstracts):429A. doi:10.1378/chest.2280986
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Abstract

SESSION TITLE: Disorders of the Pleura Global Case Reports

SESSION TYPE: Global Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Infertility is defined as the failure to conceive after one year of regular intercourse in women < 35 years not using contraception and after six months in women > 35 years. The incidence of infertility varies for different population studied, data from population based studies suggest that 10-15% of couples in the western world experience infertility. It is estimated that as many as 80 million couples are affected by infertility worldwide. Assisted reproductive technology (ART) such as in vitro fertilization (IVF) and embryo transfer (ET) has been essential in the treatment of infertility [1,2]. Ovarian hyperstimulation syndrome (OHSS) is the most serious, iatrogenic, potentially lethal complication of controlled ovarian stimulation (COS) that occurs 33 % of ovarian stimulation cycles with clinical manifestations varying from mild to severe as part of ART. Its pathogenesis is unknown but increasing of vascular permeability and third spacing, leading to hemoconcentration and inadequate end organ perfusion is thought to be the main pathophysiology of OHSS. Pleural effusion is reported in 10 % of severe OHSS cases and is usually associated with marked ascites. Isolated pleural effusion in OHSS is not frequently reported [3].Herein; we aim to describe a patient with unilateral pleural effusion due to the OHSS

CASE PRESENTATION: A 30-year-old G:0 woman with 5 years unexplained infertility and no significant past medical history or physical findings was applied to IVF center. OS was initiated. Oocyte pick up was performed. A total of 12 oocytes were retrieved. One ET was performed on 3rd day of OPU. Two days after the β-hCG positivity the patient initially presented with complaints of dyspnea. She was afebrile but tachycardic. She had 2 kg weight gain. She had shortness of breath, cough and chest pain. She had tachypnea and decreased breath sounds. All laboratory tests were also normal. Because of her pregnancy the patient and her family refused to be taken chest x-ray. USG evaluation demonstrated right pleural effusion without intraperitoneal fluid and by ultrasound examination was observed. Thoracentesis was performed and 3000 cc exudative fluid was drained. She fully recovered without sequelae.

DISCUSSION: Severe OHSS has been reported in less than 2 % of patients. It tends to be more severe and may be last longer [1]. The pathophysiology of isolated pleural effusion without ascites is not clear but the migration of fluid from the abdominal cavity to the thoracic cavity through the holes in the diaphragm is accepted as explanation of the pathophysiology[1,3]. Negative intrapleural pressure may pull the fluid from abdomen to thoracic cavity. In the present case there had neither abdominal distension nor ascites. If only abdominal cavity were examined pleural effusion could be ignored. Thinking that dyspnea is only a direct result of increased intra-abdominal pressure in OHSS patients can mislead the physicians. In severe OHSS cases dyspnea, pleural effusion, ascites, hemoconcentration are observed. In our case although there was a great amount of pleural effusion, no any other significant markers of severe OHSS were existed.

CONCLUSIONS: <span style="line-height:20.7999992370605px">First of all masive pleural effusion was thought us any other systemic disease but the patient was pregnant and she got well by thoracentesis and by supportive therapy.</span>A good complete examination of a patient in OHSS and then good supportive therapy let the prognosis of OHSS favourable. Even though there is no ascites in the abdomen, in the existence of dyspnea pleural effusion should be taken into consideration in OHSS.<span style="line-height:20.7999992370605px"> </span>

Reference #1: Weiss RV, Clapauch R. Female infertility of endocrine origin. Arq Bras Endocrinol Metabol. 2014 Mar;58(2):144-52.

Reference #2: Adegbola O, Akindele MO. The pattern and challenges of infertility management in Lagos, Nigeria Afr Health Sci. 2013 Dec;13(4):1126-9

Reference #3: Fatemi HM, Popovic-Todorovic B, Humaidan P, Kol S, Banker M, Devroey P, García-Velasco JA Severe ovarian hyperstimulation syndrome after gonadotropin-releasing hormone (GnRH) agonist trigger and "freeze-all" approach in GnRH antagonist protocol. Fertil Steril. 2014 Apr;101(4):1008-11

DISCLOSURE: The following authors have nothing to disclose: Ali Sami Gurbuz, Mustafa Calik, Emel Ebru Ozcimen, Necati Ozcimen, Saniye Calik

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