THORACIC ENDOMETRIOSIS: A RARE CASE OF CATAMENIAL BILATERAL HEMOTHORAX Sadiq MD, Azka; Faeik MD, Saif; Sivaraman MD, Sivashankar AtlantiCare Regional Medical Center, Pomona, N.J., U.S.A. INTRODUCTION IMAGING DISCUSSION TES pathogenesis are still not well understood, and its diagnosis . Thoracic endometriosis Syndrome(TES) is a rare disease but still counts for requires a high level of suspicion based on presentation, augmented the most common form of extra abdominopelvic endometriosis. It usually with X-ray, CT scan, MRI of the chest, thoracentesis, and affects women of reproductive age and characterized by the presence of bronchoscopy-directed biopsy. Optimal management of TES remains to functioning endometrial tissue in pleura, lung parenchyma, and airways. be elucidated, with medical (hormonal therapy), surgical (VATS), or . It encompasses mainly four distinct clinical entities: Catamenial combined approaches being reported in the medical literature pneumothorax (73%), catamenial hemothorax (14%), hemoptysis (7%), and parenchymal lung lesions (6%). CONCLUSION CASE DESCRIPTION Catamenial hemothorax, as compared to pneumothorax, is a rare clinical CXR Bilateral Pleural Effuisions: Initial (Left) Post Thoracocentesis (Right) presentation of TES. Most commonly presenting with unilateral hemothorax, only a . A 28 years old African-American American female patient with a past medical few cases have been reported with bilateral recurrent refractory hemothorax in history of endometriosis, adenomyosis, ovarian cyst, and infertility who association with ascites. Endometriosis syndrome is a rare and complex condition, presented to the ER with shortness of breath and abdominal distention. and diagnosis is often delayed or missed by clinicians, which can result in recurrent hospitalization and other complications. TES should be considered as a differential . Initial imaging showed bilateral pleural effusions and Ascites. diagnosis in female patients with infertility and respiratory symptoms . The patient underwent thoracentesis that was remarkable for hemothorax suspected for malignancy vs. Meig’s syndrome; further workup was unremarkable. REFERENCES . She subsequently developed recurrent effusions. 1..Tulandi T, Sirois C, Sabban H, Cohen A, Murji A, Singh SS, Chen I, Belland L. Relationship between Catamenial Pneumothorax or Non-catamenial Pneumothorax and Endometriosis. J Minim Invasive Gynecol. 2018 Mar - Apr;25(3):480- . The patient underwent bronchoscopy and right-sided VATS lower resection 483. doi: 10.1016/j.jmig.2017.10.012. Epub 2017 Oct 14. PubMed PMID: 29038042. 67% 67% 2. 5.Fukuda S, Hirata T, Neriishi K, Nakazawa A, Takamura M, Izumi G, Harada M, Hirota Y, Koga K, Wada-Hiraike O, Fujii T, with lateral pleural biopsy, diagnostic right lower lobe wedge resection, and Osuga Y. Thoracic endometriosis syndrome: Comparison between catamenial pneumothorax or endometriosis-related pneumothorax and catamenial hemoptysis. Eur J Obstet Gynecol Reprod Biol. 2018 Jun;225:118-123. doi: talc pleurodesis. 10.1016/j.ejogrb.2018.04.021. Epub 2018 Apr 20. PubMed PMID: 29704815. 3.9.Azizad-Pinto P, Clarke D. Thoracic endometriosis syndrome: case report and review of the literature. Perm J. 2014 33% Summer;18(3):61-5. doi: 10.7812/TPP/13-154. Review. PubMed PMID: 25102519; PubMed Central PMCID: PMC4116267 . The fluid cytology came back positive for endometrial stromal tissue. The 4. .3.Ottolina J, De Stefano F, Viganò P, Ciriaco P, Zannini P, Candiani M. Thoracic Endometriosis Syndrome: Association patient had a subsequent follow-up VATS on the left side and was With Pelvic Endometriosis and Fertility Status. J Minim Invasive Gynecol. 2017 Mar - Apr;24(3):461-465. doi: 10.1016/j.jmig.2016.12.025. Epub 2017 Jan 7. PubMed PMID: 28069481. recommended outpatient follow with her OBGYN for recommended hormonal 50% therapy. CT Chest w/o On Presentation (lBilateral Plueral Effusions).