Hemothorax and Hemorrhagic Ascites: A Rare Presentation of Endometriosis

Abstract

PULMONARY MEDICINE panel and complete blood count were otherwise within normal limits. Chest and abdominal computed tomography (CT) imaging revealed a large loculated right-sided pleural effusion, large-volume ascites (Figure 1) without cirrhosis and a 5 cm multicystic right adnexal mass (Figure 2). Thoracentesis and paracentesis were performed, both yielding grossly bloody fluid. Cultures and gram and acid-fast stains of both fluid samples revealed no organisms, and cytology was negative for malignancy; HIV and hepatitis serologies were negative and the serum-ascites albumin gradient was less than 1.0. A right-sided chest tube was placed to facilitate further drainage (Figure 3); this was subsequently removed after several days of minimal drainage. A transvaginal pelvic ultrasound revealed a cystic right ovarian mass with thickened, nodular internal septations. CA 125 was mildly elevated, but CEA and CA 19-9 were normal.