Catamenial Hemothorax (CH) without Respiratory Symptoms. A Case Report

Abstract

To discuss a patient presenting to ED with abdominal pain, no respiratory symptoms and incidental finding of right hemothorax, who was subsequently diagnosed with Thoracic Endometriosis Syndrome (TES). Case report. Community Hospital. A 27 year old nulligravid African American female presented with acute onset right lower quadrant pain. She had no chest pain, shortness of breath or other respiratory symptoms. Her gynecologic history was notable for dysmenorrhea. The patient was sexually active without contraceptives. Her physical exam was notable for normal vital signs (Sp02 = 99%). The pulmonary exam was remarkable for decrease breath sounds in the right lower lung field. Her abdomen was soft and tender at right lower quadrant. Pelvic exam revealed a fixed mass at the posterior fornix. Abdomino/pelvic CT scan showed hemoperitoneum and bilateral complex ovarian cysts. The CT scan revealed an incidental right pleural effusion that was subsequently confirmed by a chest X-Ray. Chest CT showed no evidence of a filling defect or mass. Lab studies: beta hCG negative. WBC = 10.5. CA-125 = 814 U/mL. Thoracocentesis yielded 2000 ml of dark brown bloody fluid and a chest tube was placed. Diagnostic laparoscopy revealed Stage IV endometriosis involving the anterior abdominal wall, anterior surface of the uterus and abdominal surface of the diaphragm. Flexible bronchoscopy was normal. Right Video Assisted Thoracoscopy (VATS) and talc pleurodesis were performed. A lung nodule was seen, resected, and sent to pathology. The parietal pleura was hemorrhagic. Biopsies from the abdomen and pelvis were negative. TES was confirmed with VATS biopsies. The patient was treated with Leuprolide Acetate and discharged.View Large Image Figure ViewerDownload Hi-res image Download (PPT) This patient represents the first reported case of CH without respiratory symptoms. Although catamenial pneumothorax is the most frequent presentation of TES (80% of cases), CH can also occur. Although uncommon, CH can present without respiratory symptoms.