Endometriosis presents with massive hemorrhagic ascites and catamenial hemopneumothorax

Aisel Alikhanova, Yinglin Gao, Gary Thompson, Sarah Duan, Ricardo Chujutall
In: Open Journal of Clinical and Medical Case Reports · 2023 · vol. 9(38) · doi:10.52768/2379-1039/2149 · W4399311862
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This case report describes a 32-year-old woman who presented with both massive hemorrhagic ascites and catamenial hemopneumothorax, rare manifestations of endometriosis.

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

This paper reports a clinical case of a 32-year-old African American woman with known endometriosis who presented with progressive abdominal distention and exertional dyspnea due to tense hemorrhagic ascites and a right hydropneumothorax/hemopneumothorax. Using diagnostic paracentesis and thoracentesis followed by chest CT and video-assisted thoracoscopic surgery (VATS) with biopsy, the authors evacuated large volumes of sanguineous fluid and confirmed stage 4 thoracic endometriosis, with cytology and tumor markers negative for malignancy; they note a key limitation that the evidence is based on a single case. After restarting oral contraceptive therapy during hospitalization, the patient reported symptom resolution by discharge and no recurrence of symptomatic ascites or pleural effusions at one month follow-up. This paper is centrally about endometriosis — specifically, it describes massive hemorrhagic ascites with thoracic endometriosis syndrome (catamenial hemopneumothorax/hemothorax) confirmed by VATS biopsy.

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Abstract

Background: Endometriosis is an inflammatory disorder in women of reproductive age where endometrial cells grow outside the uterus. Although its pathogenesis is complex and not fully understood, it’s believed to stem from a combination of factors including congenital predisposition, environmental influences, epigenetic alterations, autoimmune responses, and allergic tendencies [1]. In rare cases, it can result in hemorrhagic ascites or even thoracic endometriosis syndrome (TES), where endometrial tissue is in the thorax, potentially causing catamenial pneumothorax and catamenial hemothorax. We report a case of a 32-year-old African American woman with both hemorrhagic ascites and hemopneumothorax.

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endometriosisthoracic_endometriosis

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