Thoracic endometriosis presenting as recurrent pleural effusions

Abstract

In rare instances, endometrial glandular tissue can implant in the thorax of women suffering from endometriosis. The presentation is variable depending on site of implant and can be a rare cause of hemothorax in women. A 28-year-old woman presented with shortness of breath and was found to have a significant right sided hemothorax. The hemothorax was drained but subsequently recurred, with shortness of breath increasing around the time of her menses. Considerable workup was performed and ultimately surgery was required to diagnose her with thoracic endometriosis. This case describes how thoracic endometriosis is a challenging diagnosis and may be under reported in the literature. However, there are key elements of the disease that can prevent delay in diagnosis to reduce pain and suffering.

Keywords: Catamenial; Fibroid; Hemothorax; Pleural effusion; Pneumothorax; Thoracic endometriosis.

Fig. 1

(A) Initial posteroanterior chest radiograph showing moderate to large right sided pleural effusion (orange arrow) and a small apical right sided pneumothorax (blue arrows). (B) A lateral chest radiograph again demonstrating moderate to large right sided pleural effusion (orange arrow).

Fig. 2

Coronal (A) and sagittal (B) T2 weighted MRI of pelvis showing an enlarged fibroid uterus with a dominant 6.0 cm sub serosal fibroid at the fundus of the uterus (white arrow). Additionally, a 3.0 cm intracavitary fibroid is seen (red arrow).

Fig. 3

Coronal slice of a PET CT showing ametabolic moderately large right sided pleural effusion (white arrow). Additionally, an enlarged heterogenous uterus with calcified fibroids is demonstrated (green arrow).