{"paper_id":"268bcf7e-dc21-41f3-8289-8f56267771de","body_text":"Abstract\nBackground\nThoracic involvement is a rare extrapelvic manifestation of endometriosis. Due to the presence of endometrial‑like tissue within the thoracic cavity, cyclical respiratory or shoulder symptoms can occur. Owing to nonspecific features and limited yield of thoracic biopsies, diagnosis is often delayed. A high level of clinical suspicion is necessary to establish a diagnosis.\nCase\nA 44-year-old multiparous woman with a prior history of umbilical endometriosis presented with cyclical right-sided shoulder pain and dyspnoea. Imaging revealed haemorrhagic right-sided pleural effusion, small endometriotic cyst and moderate ascites. Extensive evaluation excluded tuberculosis, other infective pathology and malignancy. Pleural fluid analysis showed an exudative effusion with haemosiderophages, but no atypical cells. Considering the cyclical nature of symptoms, prior extrapelvic endometriosis, supportive imaging findings, and exclusion of alternative diagnoses, thoracic involvement related to endometriosis was suspected. Initial management with pleural drainage and hormonal suppression using a gonadotropin-releasing hormone agonist followed by dienogest resulted in clinical and radiological improvement of chest symptoms. So, video-assisted thoracoscopic surgery was not pursued. Definitive surgical management with total laparoscopic hysterectomy and bilateral salpingo-oophorectomy was done later. Intraoperative findings revealed extensive pelvic and peritoneal endometriotic deposits. Postoperatively, there was complete resolution of pleural effusion and ascites, and the patient has remained asymptomatic for over one year of follow-up.\nConclusion\nThoracic involvement should be considered in women with a history of endometriosis presenting with cyclical thoracic or shoulder symptoms and pleural effusion. A multidisciplinary approach and individualized medical and surgical management can achieve sustained symptom resolution.\nSimilar content being viewed by others\nAbbreviations\n- TLH + BSO:\n-\nTotal laparoscopic hysterectomy with bilateral salpingo-oophorectomy\n- TES:\n-\nThoracic endometriotic syndrome\n- CE-CT:\n-\nContrast-enhanced computed tomography\n- MRI:\n-\nMagnetic resonance imaging\n- GnRH agonist:\n-\nGonadotrophin-releasing hormone agonist\n- VATS:\n-\nVideo-Assisted thoracoscopic surgery\nReferences\nAlifano M, Trisolini R, Cancellieri A, et al. Thoracic endometriosis syndrome: current concepts in diagnosis and management. J Clin Med. 2024;13:7602.\nGarber SE, Lammers KS. Postpartum thoracic endometriosis syndrome: a case report. Cureus. 2025;17:eXXXX.\nHwang SM, Lee CW, Kim YT. Diaphragmatic and thoracic endometriosis: clinical features and surgical outcomes. Ann Thorac Surg. 2023;116:1123–30.\nTang H, Jia Q, Chen W, et al. Case report: long-term maintenance of GnRH-a combined with dienogest for thoracic endometriosis syndrome. Front Med. 2025;12:1670495.\nAcknowledgements\nWe thank the patient who gave consent to publish her data.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nConflict of interest\nAll the authors declare that they have no conflict of interest.\nEthical Approval\nWritten informed consent for publication of the clinical details and clinical images was obtained from the patient. A copy of the consent form is uploaded for review by the Editor of this journal.\nInformed Consent\nA copy of the Author’s consent form is uploaded for review by the Editor of this journal.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSusan John is a Senior Consultant Gynaecologist and Laparoscopic Surgeon; Deepsha James is a DNB Resident; and Minsa Mani is a DNB Resident.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nJohn, S., James, D. & Mani, M. A Rare Extrapelvic Manifestation of Endometriosis: Thoracic Involvment—A Case Report. J Obstet Gynecol India (2026). https://doi.org/10.1007/s13224-026-02356-0\nReceived:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s13224-026-02356-0","source_license":"CC0","license_restricted":false}