Thoracic endometriosis syndrome with bloody pleural effusion in a 28 year old woman

Thoracic endometriosis, rarely encountered, is characterized with the localization of functional endometrium tissue in pleura, lung parenchyma or tracheobronchial system. a 28 years old female patient visited our clinic with complaints of cough and shortness of breath for the last two months. right-sided massive pleural effusion was detected in the chest radiography and thorax computed tomography. exudative fluid was aspirated with a haemorrhagic appearance on thoracentesis. cytology was evaluated as suspicious. signet ring cells were reported in pleural biopsy. diagnostic biopsy was performed by video-assisted thoracic surgery (vats) on the patient whose fiber-optic bronchoscopy was normal. the histopathological diagnosis was reported as pleural endometriosis. chemical pleurodesis was applied with asbestos-free chalk. the thorax hrct (high resolution computed tomography) performed during menstruation was normal. thoracentesis was needed 3 times for recurrent pleural effusion in the follow-ups and then parietal pleurectomy was performed. the patient is in postoperative 10th month follow-up and evaluated as normal clinically and as radiologically. pleural endometriosis should be considered as a differential diagnosis in female patients with infertility with chest symptoms. video-assisted thoracoscopic surgery can be useful in the diagnosis and treatment of these patients and chemical pleurodesis and parietal pleurectomy should be considered among the treatment options.