SHM Converge Scientific Abstract ePoster Gallery-Chronic Hemothorax as a Manifestation of Thoracic Endometriosis

Pdf Summary

This case describes a 38-year-old woman with suspected endometriosis who presented with lightheadedness, palpitations, chest tightness, and mild fever. Chest CT showed a large right pleural effusion causing collapse of the right middle and lower lobes, without pulmonary embolism. Thoracentesis removed 2.2 liters of bloody pleural fluid, and a pigtail chest tube was placed. Fluid studies were negative for bacterial, anaerobic, and fungal infection; autoimmune testing was negative; and cytology showed no malignancy but did reveal hemosiderin-laden macrophages.<br /><br />Further evaluation supported thoracic endometriosis syndrome (TES) as the cause of the chronic hemothorax. Pleural fluid staining was positive for PAX8, an immunohistochemical marker associated with tissues of the female reproductive tract. Pelvic MRI also showed fibroids and findings suggestive of endometriosis. The patient did not require thoracic surgery and improved with drainage.<br /><br />The report highlights that TES is uncommon, with the most frequent presentation being recurrent catamenial pneumothorax. Pleural effusion or chronic hemothorax is a much rarer manifestation, with only 176 reported cases. Diagnosis depends on identifying endometrial glands and stroma in tissue, often aided by markers such as ER, PR, CD10, IFITM1, and PAX8. Because there are no standardized diagnostic criteria, evaluation requires a multidisciplinary approach and exclusion of more common causes of hemothorax, including malignancy, infection, and autoimmune disease.<br /><br />Overall, the case emphasizes considering thoracic endometriosis in reproductive-age women with unexplained hemorrhagic pleural effusion.

Asset Subtitle

Caitlin Grace

Meta Tag

Author List Caitlin Grace, Christine M. Doherty, Michael Dienstbach, Mohamed Gafeer

Category Clinical Vignettes

Concept Thoracic Endometriosis Syndrome

Concept Bloody Pleural Effusion

Concept Prevalence

Concept Clinical Manifestation

Concept Differential Diagnosis

Distinguished Non-Finalist

Presenter Organization The Ohio State University

Presenting Author Caitlin Grace

Track Adult

Keywords

thoracic endometriosis syndrome

hemothorax

bloody pleural effusion

endometriosis

PAX8

catamenial pneumothorax

pleural effusion

hemosiderin-laden macrophages

reproductive-age women

multidisciplinary diagnosis

Thoracic Endometriosis Syndrome

Bloody Pleural Effusion

Prevalence

Clinical Manifestation

Differential Diagnosis