Files
Division
East Florida
Hospital
HCA Florida Aventura Hospital
Specialty
Internal Medicine
Document Type
Poster
Publication Date
2025
Keywords
Thoracic endometriosis syndrome, pleural effusion, endometriosis
Disciplines
Critical Care | Female Urogenital Diseases and Pregnancy Complications | Internal Medicine | Respiratory Tract Diseases | Surgery
Abstract
Introduction: Thoracic endometriosis syndrome (TES) is a rare condition in which functional endometrial tissue spreads to the thoracic cavity. Manifestations of TES include catamenial hemoptysis, pneumothorax, and pleural effusions along with symptoms of dyspnea, cough, and pleuritic chest pain.1 Approximately 6 to 10% of women of reproductive-age women develop TES with concurrent pelvic endometriosis in 80% of patients.2 Treatment of TES includes medical management with progesterone-based oral contraceptive pills (OCPs) and surgical management involving cardiothoracic surgery. We present a case of recurrent pleural effusions in a patient who was non-compliant with medical management of TES. Methods: Data was collected during this admission. Case Description: Patient is a 35-year-old female with a history of uterine fibroids, right-sided pleural effusion secondary to TES, presented with a dry cough and progressive dyspnea. Duration of symptoms lasted for 2 weeks before seeking medical attention from her established pulmonologist and cardiothoracic surgeon. About 1 month prior to onset of symptoms, she stopped taking daily OCP, progesterone-drospirenone, due to her desire for pregnancy. MRI chest revealed a right-sided pleural effusion with regions of nodular pleural thickening, in addition to a new right hemi-diaphragmatic lesion. In 2018, she had a similar presentation in addition to pleuritic chest pain that radiated to the right subscapular region with similar findings on CT chest at that time. The patient underwent a video-assisted thoracoscopic surgery (VATS) and pleurodesis with a cytology revealing endothelial glandular tissue and blood. Given her history of TES, the patient underwent a second VATS and pleurodesis with similar cytology results from the pleural fluid. Pathology of the right hemi-diaphragmatic lesion revealed endometrial glandular and stromal tissue. She was managed post-operatively for 1 week and discharged home with instructions to resume OCPs. Discussion: Extra-pelvic endometriosis may occur in different areas of the body, including the thoracic cavity, gastrointestinal tract, and urinary tract. The pathophysiology of TES is based upon Sampson’s theory of retrograde menstruation, in which endometrial cells travel from the fallopian tubes into the peritoneal cavity to the right paracolic gutter and travel to the pleural cavity via transperitoneal-transdiaphragmatic migration from either acquired fenestrations in the diaphragm or congenital anomaly. 1 Without progesterone-based OCPs, migrated endometrial tissue will proliferate and result in breakthrough bleeding, leading to accumulation of fluid in the thoracic cavity. Conclusion: Although the incidence of TES is approximately 6 to 10% of reproductive-age women, researchers hypothesize that the incidence rate is much higher. This is mainly due to underdiagnosis and under-reporting cases in general. Unfortunately, underdiagnosis is common in patients with TES, given that the risk factors and clinical presentation may mimic more prevalent conditions in pulmonology and gynecology. Even with recent advancements in medicine and surgery, studies have reported recurrence rates of 14.3 to 55%, making management and symptom relief challenging.3 While the recurrence rate remains high, it is imperative to educate patients on medication compliance, routine follow-up with respective specialties, and signs and symptoms of recurrence. Bringing awareness of risk factors and clinical presentation can assist clinicians in making an early diagnosis of TES.
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Gopala-Rao, Kevin; Santiesteban, Luis; Tormo Carrillo, Carmen; Almanzar Zorilla, Christian; and Danckers, Mauricio, "A Case of Recurrent Pleural Effusion Secondary to Thoracic Endometriosis Syndrome After Discontinuation of Oral Contraceptives" (2025). East Florida Division GME Research Day 2025. 48.
https://scholarlycommons.hcahealthcare.com/eastflorida2025/48
Included in
Critical Care Commons, Female Urogenital Diseases and Pregnancy Complications Commons, Internal Medicine Commons, Respiratory Tract Diseases Commons, Surgery Commons