A Rare Extrapelvic Manifestation of Endometriosis: Thoracic Involvment—A Case Report

Background Thoracic 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. Case A 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.

Thoracic 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. Similar content being viewed by others Abbreviations - TLH + BSO: - Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy - TES: - Thoracic endometriotic syndrome - CE-CT: - Contrast-enhanced computed tomography - MRI: - Magnetic resonance imaging - GnRH agonist: - Gonadotrophin-releasing hormone agonist - VATS: - Video-Assisted thoracoscopic surgery

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We thank the patient who gave consent to publish her data. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest All the authors declare that they have no conflict of interest. Ethical Approval Written 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. Informed Consent A copy of the Author’s consent form is uploaded for review by the Editor of this journal. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Susan John is a Senior Consultant Gynaecologist and Laparoscopic Surgeon; Deepsha James is a DNB Resident; and Minsa Mani is a DNB Resident. Rights and permissions Springer 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. About this article Cite this article John, 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 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s13224-026-02356-0