Pleural endometriosis: an exceptional cause of hemorrhagic pleural effusion.

Abstract

The differential diagnosis of bloody pleural effusions is relatively narrow. Trauma, iatrogenic or otherwise, represents the most common cause of hemothorax. Other common causes of bloody pleural effusion include malignancy (primary or metastatic), tuberculosis, pulmonary embolism, and serositis from collagen vascular diseases such as rheumatoid arthritis and systemic lupus erythematosus. Clinical history along with pathologic, microbiologic, and biochemical evaluation pleural fluid evaluations confirm the diagnosis in most cases. However, if repeated pleural fluid examination reveals only hemorrhagic effusion without corroborative history or mass lesion in lung, or evidence of microorganisms, then a search for uncommon etiology is necessary. Endometriosis most commonly occurs in the ovaries, uterine ligaments, rectovaginal septum, Cul-de-sac, and the surrounding peritoneum of pelvic organs [1]. Thoracic endometriosis syndrome (TES) is an exceptional condition. There were reported only 38 pathologically documented cases of TES (pleural–21 cases, and parenchymal–17 cases) in the literature till the year 2000 [1]. One such rare case of pleural endometriosis which created an enormous diagnostic dilemma and ultimately confirmed by histopathologic study is being described.