CATAMENIAL HEMOTHORAX DIAGNOSIS OBSCURED BY VATS BIOPSY

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Hemothorax is most commonly caused by trauma, but can also result from iatrogenic injury, rupture pleural adhesions, neoplasm, complication anticoagulation, aneurysmal rupture, pulmonary vascular malformations, endometriosis, and exostoses. A recurrent right-sided hemothorax, with a temporal relation to menses, in young female distinguishes thoracic endometriosis other etiologies. Video assisted thoracoscopic Surgery (VATS) thought as definitive diagnostic procedure for diagnosis endometriosis. We present case right sided whose was obscured two negative biopsies obtained via VATS. CASE PRESENTATION: 36-year-old history embolism s/p presented dyspnea on exertion, pleuritic chest pain, bleeding umbilical mass, worsened menses. She had three years hemorrhagic effusions unknown etiology. undergone pleurectomy VATS prior. The biopsy showed tissue mesothelial cell hyperplasia chronic inflammation. repeat performed one year later, conversion open thoracotomy, nodule demonstrated foreign body reaction, likely talc. No endometrial found. Patient underwent decortication at this time. During her work up, patient been trialed Depo Provera, without improvement. Biopsy mass presumptive syndrome made, plans start GnRH antagonist therapy. DISCUSSION: Catamenial hemothorax ectopic implantation directly cavity or abdominal implantations that bleed into retrograde manner. In both cases, disease manifestation fluctuates temporally For reason, may have limited ability rule out workup hemothorax. McCann et al. further elaborate limitations catamenial identifying decrease yield when outside menstruation which they attribute degradation autolysis proliferative tissues approximately 48 hours after menstruation. CONCLUSIONS: This illustrates use be misleading diagnosing due various sites fluctuations tissue. REFERENCE #1: Boersma WG, Stigt JA, Smit HJ. Treatment haemothorax. Respir Med. 2010 Nov;104(11):1583-7. doi: 10.1016/j.rmed.2010.08.006. PMID: 20817498. #2: Joseph-Vempilly J. Clinical features, approach treatment adults In: UpToDate, Post, TW (Ed), Waltham, MA, 2020 #3: MR, Schenk WB, Nassar A, Maimone S. Thoracic presenting discordant video-assisted surgery. Radiology Reports. Sept;15(9):1419-22. 10.1016/j.radcr.2020.05.064. 32642009. DISCLOSURES: relevant relationships Preeti Gupta, source=Web Response Margaret Kliebhan,