Signs and Symptoms of Chest Diseases: Student/Resident Case Report Poster - Signs and Symptoms of Chest Disease |

Massive Hemothorax as a Complication of Thoracic Endometriosis Syndrome FREE TO VIEW

Julien Nguyen, MD; Nader Kamangar, MD
Author and Funding Information

Olive View-UCLA Medical Center, Sylmar, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1255A. doi:10.1016/j.chest.2016.08.1368
Text Size: A A A
Published online

SESSION TITLE: Student/Resident Case Report Poster - Signs and Symptoms of Chest Disease

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Endometriosis often afflicts the pelvic structures, but its insidious involvement of extrapelvic structures can pose additional diagnostic challenges. Pulmonary involvement leading to thoracic endometriosis syndrome (TES) can manifest as catamenial pneumothorax, hemothorax, hemoptysis, and pulmonary nodules, each accounting for 73%, 14%, 7%, and 6% of cases, respectively. We present a patient with three of these TES manifestations, who is further distinguished by an uncharacteristically massive hemothorax not previously described.

CASE PRESENTATION: A 39-year-old hypertensive woman presented with four months of progressive shortness of breath, dry cough, right-sided chest pain, and three-pillow orthopnea with occasional exacerbations coinciding with menstruation onset. Chest radiograph revealed a near-complete right lung opacification (Fig. 1) with right lung collapse and contralateral mediastinal shift on CT angiogram of the chest. Chest tube thoracostomy yielded 4.4L of a frankly bloody, lymphocyte-predominant, exudative pleural effusion with 452,500 red blood cells and hematocrit of 15 (serum hematocrit 31.7). Serologic and pleural infectious and rheumatologic evaluations were grossly negative. CT of the chest, abdomen, and pelvis demonstrated a small right-sided loculated hydropneumothorax and right pleural-based nodule (Fig. 2) with scattered micronodules bilaterally as well as pelvic adnexal fluid collections. Recurrence of her symptoms two months later prompted video-assisted thoracoscopic surgery with doxypleurodesis, where biopsies confirmed the presence of pleural endometriosis implants.

DISCUSSION: Catamenial hemothorax is an infrequent entity that demonstrates a predilection for the right hemithorax in 85-95% of cases with effusions ranging from 200-2000mL, while pulmonary nodules caused by parenchymal implants are rarer still compared to catamenial pneumothoraces. Blunt, penetrating, and iatrogenic traumas remain the leading cause of hemothoraces, followed by infectious, malignant, and coagulopathic etiologies among others. Massive hemothoraces, however, are often seen in the context of cardiovascular injury, further highlighting the remarkable catamenial etiology to our patient’s massive hemothorax that was more than double the size documented in the literature.

CONCLUSIONS: A wide array of diagnostic and therapeutic modalities exist in the management of TES, but clinical suspicion remains of utmost importance to avoid misdiagnosis and delay of care. Synthesizing a history of cyclical symptoms and considering unusual causes for an extraordinarily massive hemothorax with concurrent lung nodules and a pneumothorax ultimately led to the diagnosis of TES in our patient.

Reference #1: Alifano M, Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge. Ann Thorac Surg. 2006;81(2);761-769.

Reference #2: Azizad-Pinto P, Clarke D. Thoracic endometriosis syndrome: case report and review of the literature. Perm J. 2014;18(3):61-65.

DISCLOSURE: The following authors have nothing to disclose: Julien Nguyen, Nader Kamangar

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543