A recurrent, bloody pleural effusion (when fluid mixed with blood accumulates between the pleural membranes surrounding the lungs) poses a serious diagnostic challenge. In such cases, doctors most often suspect tuberculosis, cancer, or autoimmune (collagen-vascular) diseases.
However, there is also a much rarer cause: the catamenial hemothorax, which is the thoracic endometriosis syndrome one of its forms.
Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. Approximately Affects 11%. Although it most often occurs in the pelvis, among the sites outside the uterus, The chest is the most common, even if this is generally considered rare.
In this case, a A 33-year-old woman who is also struggling with infertility present its history.
For the past six months, he has had shortness of breath on exertion and an occasional dry cough. He had previously been treated for cervical lymph node tuberculosis, so this was initially considered a possible cause.
In four months They had to drain fluid from his chest three times, because it kept piling up again and again.
Laboratory tests did not reveal any cancer cells or the bacteria that cause tuberculosis. The chest CT scan also did not reveal any tumors, inflammation, or other abnormalities that could explain the recurrent hemorrhagic effusion.
Since the diagnosis was still unclear, thoracoscopy They performed the procedure. During the procedure, they observed not only the bloody fluid but also a small, reddish lesion on the pleura, from which they took a tissue sample.
Microscopic examination revealed that this lesion It was endometrial tissue. A specialized immunohistochemical test (PAX8 and CD10 staining) clearly confirmed this.
To prevent fluid from accumulating again pleurodesis A procedure was performed in which the two layers of the pleura were sealed together with talcum powder, thereby eliminating the space where fluid could accumulate again.
In addition, the patient monthly GnRH analog hormone therapy for three months received, which temporarily halts hormone production in the ovaries and thereby reduces the activity of endometriosis.
Three months later, based on the follow-up chest X-ray, the fluid accumulation did not return.
The authors emphasize that the Catamenial hemothorax is the second most common symptom of thoracic endometriosis, approximately In 14% it happens, and In approximately 80% of cases, it affects the right side of the chest.
It often takes months or even years to reach a diagnosis because the disease is rare and its symptoms can easily be mistaken for those of other diseases.
The most reliable method for making a diagnosis at this time is the VATS (video-assisted thoracic surgery), which allows for a chest examination, tissue sampling, and, if necessary, the removal of endometriosis lesions—all at the same time.
The definitive diagnosis is always made through a histological examination, during which glands and connective tissue characteristic of endometriosis are identified. If the diagnosis is unclear, special stains—such as the CD10 – can help confirm the diagnosis.
According to current professional guidelines, the The most effective treatment is a combination of VATS surgery and GnRH-analog hormone therapy, which simultaneously treats existing chest lesions and reduces the likelihood of their recurrence.
This rare case clearly illustrates that endometriosis It may not be limited to the pelvis: In certain cases, it can spread through the diaphragm into the chest, where it may cause recurrent chest bleeding, fluid accumulation, pneumothorax, or chest pain. For this reason, in any woman of childbearing age who experiences recurrent right-sided chest symptoms of unknown origin—especially if they occur at the same time as menstruation—it is important to consider the the possibility of pelvic endometriosis.
Source: Kamath A, Nair JP, Sinha T, Mallya M, Thorve SM, Mishra H, Shenurkar A. When It’s Not Just “That Time of the Month”: Identifying Thoracic Endometriosis in the Context of Recurrent Pleural Effusion. J Assoc Physicians India. June 2026;74(6S):17-19. doi: 10.59556/japi.74.1018. PMID: 42543962
Here’s an important point from my own clinical practice in health psychology and lifestyle medicine.
Lately, even in my own clinical practice, I’ve been seeing more and more women who have been diagnosed with thoracic endometriosis or who come to see me with a suspicion of it. This carries a particularly important message: although we’re talking about a rare condition, there are likely far more people affected among us than are currently being diagnosed.
As a clinical health psychologist, I see that these women are not only suffering physically, but are also carrying an enormous psychological burden. Recurring chest pain, shortness of breath, hemothorax, or even pneumothorax are extremely frightening symptoms. It’s completely understandable that many of them begin to feel anxious, experience panic attacks, or remain in a constant state of alert, monitoring every signal their bodies send.
Unfortunately, this can easily lead to a vicious cycle. Because thoracic endometriosis is rare, diagnosis is often delayed, tests take a long time, and the patient lives in uncertainty for an extended period—and, naturally, experiences anxiety during this time. Anxiety, however, can even trigger similar symptoms, which is why doctors may unfortunately be reassured if imaging tests show no significant abnormalities—which can easily happen— plus timing can also play a significant role—and the patient is anxious, they may mistakenly attribute the symptoms to the patient’s mental state, when in fact a serious, organic disease is the underlying cause. This further increases patients’ vulnerability and loss of self-confidence, and can have serious consequences.
For this very reason, the role of the clinical health psychologist in the care of patients with thoracic endometriosis is not limited to providing psychological support. They help patients process the uncertainty associated with the diagnosis, reduce chronic stress and anxiety, and support patients in regaining a sense of control and quality of life despite their symptoms. Appropriate psychological support can be an essential complement to medical treatment. It is particularly important to teach those affected how to distinguish and recognize symptoms caused by anxiety, how to manage them, and how to communicate with their doctor so that they are taken seriously and receive the necessary evaluation—even if they’ve already been dismissed as “hysterical, panicky bitches”—excuse my language, but I’m quoting my patient. This knowledge can literally save a life in this specific case! If you’ve ever been in this situation, or if you’re worried that you weren’t examined thoroughly enough—or if you were examined but still can’t feel at ease—sign up for an online health psychology consultationa HERE.
About me
Hi, I’m Nóra Árvai, a clinical health psychologist, health communication specialist, and PhD researcher in the field of medical foresight. I’ve been working with women living with chronic illnesses for over 16 years, particularly those affected by endometriosis and infertility. Through more than 28,000 consultation hours, I’ve learned one thing for sure: reliable knowledge, the right support, and a strong community can truly change lives.
Over the past few years, I have written 14 books and published thousands of articles, and I have made it my mission to present the latest scientific findings in an accessible way to women who want to take back control of their own health.
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