Catamenial Haemorrhagic Pleural Effusion Caused by Thoracic Endometriosis, which was Controlled by Surgery Undertaken after Failed Medical Management

Our plain-English summary of Catamenial Haemorrhagic Pleural Effusion Caused by Thoracic Endometriosis, which was Controlled by Surgery Undertaken after Failed Medical Management, by M.F.K. Hassanein, V. Herminie, N.T. James, et al (European Journal of Case Reports in Internal Medicine, 2024).

The study

• Authors: M.F.K. Hassanein, V. Herminie, N.T. James, D. Chetty
• Journal: European Journal of Case Reports in Internal Medicine
• Published: 2024;11(8):004613
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Unlabelled: 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.

Learning Points: Thoracic endometriosis syndrome is a rare but significant cause of haemorrhagic pleural effusion in women of childbearing age.Diagnosis and treatment can be challenging, and a multidisciplinary approach has been found to improve outcomes.

© EFIM 2024.

In plain English

This case report described a 30-year-old woman who had never been pregnant, at Seychelles Hospital. It is not a study of asbestos. The authors listed asbestos only among possible causes of bloody fluid around the lung and did not say whether the patient had been exposed. She first presented in October 2022 with cough, breathlessness and fluid around the right lung. Draining it removed 820 ml of dark red fluid, and a blood marker, CA-125, was raised (172.9 U/ml). The worsening breathlessness and fluid came around the time of her periods. Hormone tablets (norethisterone, then danazol) did not stop the symptoms, and she was readmitted in January and March 2023. Keyhole chest surgery removed three small lesions from the right diaphragm. Tissue tests confirmed pleural endometriosis, meaning tissue like the womb lining growing in the chest. After surgery and six months of goserelin injections, she had no symptoms at almost one year, and a chest X-ray showed no return of the fluid. The authors concluded that a multidisciplinary approach has been found to improve outcomes in this rare condition.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (one patient)
• Who was studied: One 30-year-old nulligravida woman treated at Seychelles Hospital, Victoria, Seychelles, first seen in October 2022 and followed to about one year after surgery (2024)
• Exposure: Asbestos was not studied. The article does not say whether the patient had been exposed to asbestos. Asbestos appears only in the introduction's list of possible causes of haemorrhagic pleural effusion. The condition studied was thoracic endometriosis.
• Main results:
  • In the patient, thoracocentesis drained 820 ml of dark red fluid, which was exudative on biochemistry.
  • The patient's CA-125 was markedly elevated at 172.9 U/ml; at a later admission it was 86.48 U/ml.
  • The patient's episodes of increased shortness of breath and pleural effusion occurred around the time of her period.
  • Medical treatment with norethisterone did not control the symptoms; the patient was readmitted in January 2023, switched to danazol, and admitted again in March 2023.
  • At thoracoscopy, three sub-centimetre lesions on the right diaphragmatic pleura were removed. Biopsy findings were consistent with pleural endometriosis, with stromal fragments expressing CD10, oestrogen and progesterone receptors.
  • After surgery and six months of goserelin, the patient was asymptomatic at almost one year after surgery, and the follow-up chest X-ray showed no recurrence of pleural effusion.
• The authors' conclusion: The authors concluded that thoracic endometriosis syndrome is a rare presentation of endometriosis, that diagnosis and treatment can be challenging, and that a multidisciplinary approach has been found to improve outcomes.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Multidisciplinary Team.

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