Catamenial Pneumothorax in a Patient with Endometriosis: A Case Report

Mary Rometti, Laryssa Patti
Cureus · 2023 · doi:10.7759/cureus.42193 · W4385009069
article OA: diamond CC0 ⤵ 2 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a patient who presented with abdominal pain and was found to have a pelvic hematoma and hemothorax, ultimately diagnosed as thoracic endometriosis causing catamenial pneumothorax.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a 38-year-old menstruating woman presenting to the emergency department with several days of crampy lower abdominal pain, who was found on CT imaging to have a large pelvic hematoma with active extravasation and a large right pleural effusion/hypothesized hemothorax. Following hemodynamic instability and decline in hemoglobin, she underwent diagnostic laparoscopy that revealed approximately 1 liter of dark red blood and clots throughout the abdomen plus endometrial lesions, dense adhesions, and no diaphragmatic injury or identifiable bleeding source; a right chest tube then drained hemorrhagic pleural fluid. Pleural cytology showed chronic inflammatory and reactive mesothelial cells with negative malignant cells and cultures, and she was discharged on continuous oral contraceptive pills for menstrual suppression. A major limitation is that no biopsies were performed intraoperatively, leaving the endometriosis diagnosis based on intraoperative findings rather than tissue confirmation. This paper is centrally about endometriosis — specifically thoracic endometriosis presenting as catamenial pneumothorax/hemothorax alongside pelvic disease.

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Abstract

Pelvic pain is a common presentation to the emergency department (ED). For female patients, endometriosis can be difficult to diagnose and can have life-threatening complications if missed. In this case report, we present a case of a patient initially presenting to the ED with a few days of crampy lower abdominal pain. After initial imaging, she was found to have a large pelvic hematoma with concern for active extravasation and a large hemothorax. After further evaluation, she was suspected of having endometriosis leading to thoracic endometriosis and a catamenial pneumothorax. Although endometriosis is not typically an emergent diagnosis, the complications of significant endometrial tissue spread can cause life-threatening impacts. Clinicians should consider complications of endometriosis in females of menstruating age.

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Condition tags

endometriosisthoracic_endometriosis

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