Catamenial haemorrhagic pleural effusion caused by thoracic endometriosis, which was controlled by surgery undertaken after failed medical management
  • Mahmoud Farouk Kamel Hassanein
    Department of Internal Medicine, Seychelles Hospital, Healthcare Agency, Victoria, Seychelles
  • Venessa Herminie
    Department of Internal Medicine, Seychelles Hospital, Healthcare Agency, Victoria, Seychelles
  • Nuhu Teri James
    Department of Obstetrics and Gynaecology, Seychelles Hospital, Healthcare Agency, Victoria, Seychelles
  • Danisela Chetty
    Department of General Surgery, Seychelles Hospital, Healthcare Agency, Victoria, Seychelles

Keywords

Haemorrhagic pleural effusion, haemothorax, thoracic endometriosis, catamenial pain, catamenial haemothorax

Abstract

Haemorrhagic pleural effusion can be a challenging diagnosis that requires a thorough investigation and sometimes a multidisciplinary team of physicians to reach the underlying aetiology. Causes can include pulmonary malignancy, pulmonary infections, connective tissue diseases, asbestos associated, intra-abdominal conditions such as pancreatitis and ovarian tumours, cardiovascular disorders such as ruptured aneurysms and pulmonary infarction, as well as other miscellaneous causes. One such cause is endometriosis in the thoracic cavity. Endometriosis is a chronic illness associated with the occurrence of endometrial tissue outside the endometrium. Insertion of endometrial tissue in the thoracic cavity is rare, with only a few cases described. This case report gives detail of a 30-year-old nulligravida suspected of having thoracic endometriosis following a history of catamenial dyspnoea and associated pleural effusion. The diagnosis was confirmed through the histopathological study of tissue obtained via thoracoscopic surgery. Excision of the endometrial tissue was done, and the patient then continued medical treatment with progestins and gonadotrophin-releasing hormone (GnRH) agonists. Following therapy, the index patient was asymptomatic. A multidisciplinary approach is often needed in the diagnosis and management of thoracic endometriosis, involving both medical and surgical specialities. Minimally invasive surgery is the gold standard of diagnosis, allowing for direct visualisation of implants and nodules and should be followed by medical treatment to reduce the risk of recurrence. Medical therapy alone is associated with higher rates of recurrence. Physicians must have a high degree of suspicion as thoracic endometriosis is a disease that can often be missed.

VIEW THE ENTIRE ARTICLE

References

  • Kumar S, Verma SK, Singh R, Prasad R. Hemorrhagic pleural effusion secondary to sarcoidosis: a brief review. Ann Thorac Med 2009;4:27–31.
  • World Health Organization, 2023. Endometriosis [Fact Sheet] https://www.who.int/news-room/fact-sheets/detail/endometriosis#:~:text=Endometriosis%20is%20a%20disease%20in,period%20and%20last%20until%20menopause. Accessed on 1st February 2024
  • Yao J, Zheng H, Nie H, Li CF, Zhang W, Wang JJ. Endometriosis of the lung: a case report and review of literature. World J Clin Cases 2023;11:4326–4333.
  • Porcel JM, Sancho-Marquina P, Monteagudo P, Bielsa S. Pleural effusion secondary to endometriosis: a systematic review. Am J Med Sci 2023;366:296–304.
  • Duyos I, López-Carrasco A, Hernández A, Zapardiel I, de Santiago J. Management of thoracic endometriosis: single institution experience. Eur J Obstet Gynecol Reprod Biol 2014;178:56–59.
  • Nezhat C, Main J, Paka C, Nezhat A, Beygui RE. Multidisciplinary treatment for thoracic and abdominopelvic endometriosis. JSLS 2014;18:e2014.00312.
  • BSGE and RCOG joint statement on thoracic endometriosis care in the United Kingdom. Available at: https://www.rcog.org.uk/media/4iulq0ug/bsge-statement-on-thoracic-endometriosis-care-in-the-uk.pdf
  • Ciriaco P, Muriana P, Lembo R, Carretta A, Negri G. Treatment of thoracic endometriosis syndrome: a meta-analysis and review. Ann Thorac Surg 2022;113:324–336.
  • Singh M, Singh RB, Singh AB, Carballo AL, Jain A. Thoracic endometriosis: still a diagnostic dilemma. Cureus 2021;13:e15610.
  • European Society of Human Reproduction and Embryology (ESHRE). ESHRE guideline endometriosis, 2022. Available at: https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline.aspx
  • Falcone T, Flyckt R. Clinical management of endometriosis. Obstet Gynecol 2018;131:557–571.
  • Views: 528
    HTML downloads: 26
    PDF downloads: 136


    Published: 2024-07-01
    Issue: 2024: LATEST ONLINE (view)


    How to cite:
    1.
    Hassanein MFK, Herminie V, James NT, Chetty D. Catamenial haemorrhagic pleural effusion caused by thoracic endometriosis, which was controlled by surgery undertaken after failed medical management. EJCRIM 2024;11 doi:10.12890/2024_004613.