Recurrent Hemothorax and Hemoperitoneum in Endometriosis: A Case Report

Sarah Park, Sarah S Park, Justin Peterson, Justin W. Peterson
Cureus · 2025 · vol. 17(8) , pp. e89503 · doi:10.7759/cureus.89503 · PMID:40918755 · PMC12413240 · W4413014165
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a 34-year-old woman with recurrent, cyclical hemothorax and hemoperitoneum caused by extra-pelvic endometriosis, emphasizing diagnostic and treatment challenges.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This case report describes a 34-year-old woman with laparoscopically diagnosed endometriosis who developed recurrent, cyclical hemorrhagic right pleural effusions and episodes of hemoperitoneum/ascites over several years, despite multiple prior surgeries for ectopic implants. After initial presentation with severe pleuritic chest pain two days after her last menstrual period, thoracentesis produced grossly bloody exudative fluid and the timing supported thoracic endometriosis, though the patient was initially admitted for presumed COVID-19 pneumonia and given antibiotics; later recurrence followed cessation of hormonal therapy due to an allergic reaction, and pleuroscopy/biopsy instead showed fibrinous pleuritis with reactive mesothelial hyperplasia with no endometriosis identified. The authors note diagnostic challenges in achieving pathologic confirmation and persistent symptoms even after diagnosis. This paper is centrally about endometriosis — it reports recurrent catamenial hemothorax and hemoperitoneum attributed to extra-pelvic (thoracic and intraperitoneal) endometriosis.

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Abstract

Extra-pelvic endometriosis, defined as the presence of endometrial tissue or stroma outside of the pelvic cavity, is a rare cause of hemothorax and hemoperitoneum. Here, we present a case of a 34-year-old woman with a history of endometriosis who experienced recurrent, cyclical episodes of hemorrhagic pleural effusions and ascites. Despite multiple surgeries to address the ectopic endometrial implants, her symptoms persisted for years without definitive resolution, illustrating the challenges of treatment even after the diagnosis has been established. This case highlights the rare manifestations of extra-pelvic endometriosis and the long-term complications they may pose. Early recognition and intervention are crucial to prevent chronic sequelae and reduce morbidity.

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endometriosis

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