Postpartum Spontaneous Hemothorax Strongly Suggestive of Thoracic Endometriosis Syndrome: A Case Report

Fujii M, Mari Fujii, Takahiro Honda, Honda T, Tauchi S, Shunsuke Tauchi, Naoto Ishimaru, Ishimaru N
Internal medicine (Tokyo, Japan) · 2026 · doi:10.2169/internalmedicine.8193-26 · PMID:42907392
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⚙ AI-generated summary by qwen3.7-flash, 2026-10-25 ⓘ

This case report describes a 34-year-old woman who developed spontaneous hemothorax postpartum, with surgical findings and pleural fluid analysis suggesting thoracic endometriosis syndrome as the underlying cause.

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⚙ AI-generated deep summary by qwen3.7-flash, 2026-10-25 · read from full text ⓘ

A 34-year-old woman presented with fever and dyspnea eight days postpartum, initially misdiagnosed as pyelonephritis despite a transudative pleural effusion. Her condition deteriorated rapidly into hemothorax, prompting video-assisted thoracoscopic surgery which identified multiple hematoma-like lesions on the visceral pleura. Elevated pleural fluid CA-125 levels and the presence of pigment-laden macrophages supported a diagnosis of thoracic endometriosis syndrome rather than a systemic postpartum complication. This case report emphasizes that new hemorrhagic changes in postpartum pleural effusions should trigger reassessment for thoracic endometriosis syndrome. Relevance to endometriosis: this paper is centrally about endometriosis, specifically describing a rare presentation of thoracic endometriosis syndrome manifesting as spontaneous hemothorax in the postpartum period.

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Abstract

A 34-year-old woman developed fever, dyspnea, and hypoxemia 8 days after vaginal delivery and was treated for pyelonephritis with bacteremia. The right dominant pleural effusion was initially clear and transudative, suggesting a systemic postpartum cause. However, sudden chest pain and worsening hypoxemia were followed by the rapid enlargement of the effusion, and repeat thoracentesis revealed hemothorax. Video-assisted thoracoscopic surgery revealed multiple small hematoma-like lesions on the visceral pleura. Markedly elevated pleural fluid CA-125 levels and pigment-laden macrophages suggested thoracic endometriosis syndrome. This case highlights that new hemorrhagic changes in postpartum pleural effusion warrant reassessment, including consideration of thoracic endometriosis syndrome.
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Postpartum Spontaneous Hemothorax Strongly Suggestive of Thoracic Endometriosis Syndrome: A Case Report Article ID: 8193-26 Details Abstract A 34-year-old woman developed fever, dyspnea, and hypoxemia 8 days after vaginal delivery and was treated for pyelonephritis with bacteremia. The right dominant pleural effusion was initially clear and transudative, suggesting a systemic postpartum cause. However, sudden chest pain and worsening hypoxemia were followed by the rapid enlargement of the effusion, and repeat thoracentesis revealed hemothorax. Video-assisted thoracoscopic surgery revealed multiple small hematoma-like lesions on the visceral pleura. Markedly elevated pleural fluid CA-125 levels and pigment-laden macrophages suggested thoracic endometriosis syndrome. This case highlights that new hemorrhagic changes in postpartum pleural effusion warrant reassessment, including consideration of thoracic endometriosis syndrome. © 2026 by The Japanese Society of Internal Medicine This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license. https://creativecommons.org/licenses/by-nc-nd/4.0/ Favorites & Alerts Recently viewed articles Predecessor

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