Hemothorax resulting from hemorrhagic degeneration of giant uterine leiomyomata: A rare variant of pseudo-Meigs' syndrome

Abstract

Though rare, hemothorax can occur without trauma, coagulopathy, or apparent vascular injury. Similar to the proposed mechanism of Meigs' syndrome or hepatic hydrothorax, small diaphragmatic defects may allow peritoneal fluid to traverse the diaphragm into the pleural space. While typically this is associated with transudative pleural effusions, there have been case reports of hemoperitoneum crossing the diaphragm into the pleural space. Here, we present a case in which multiple giant leiomyomata with hemorrhagic necrosis led to hemoperitoneum that translocated across the diaphragm into the pleural space, causing a hemothorax.

Keywords: Hemoperitoneum; Hemothorax; Leiomyoma.

Fig. 1

A: Coronal reconstruction from the patient's initial computed tomography (CT) angiography of the chest performed at the outside hospital showing near-total replacement of the abdominopelvic contents by a giant, conglomerate, vascularized mass or masses with displacement of normal abdominal viscera, most notably into the left upper quadrant. Likewise present is small-volume perihepatic ascites. B: Axial image from the same CT angiogram as in panel A showing a small right pleural effusion. A small amount of right upper quadrant and left upper quadrant ascitic fluid is also noted.

Fig. 2

A: Axial image from computed tomography (CT) angiography of the chest performed at our institution showing a now-moderate right pleural effusion with compressive atelectasis. B: Axial image at the level of the pelvis from the patient's pre-operative contrast-enhanced CT showing high-attenuation ascitic fluid adjacent to part of the patient's giant, necrotic abdominopelvic mass.