2025 Volume 39 Issue 2 Pages 132-138
We report a patient with bilateral thoracic endometriosis pneumothorax and left pneumothorax as the initial presentation who showed a diaphragmatic pore on the right side. A 42-year-old nullipara woman with a history of right salpingo-oophorectomy showed right pleural effusion on abdominal ultrasonography after treatment for hepatitis C virus infection. A plain chest radiograph was obtained to evaluate the pleural effusion, and it revealed an incidental left pneumothorax (grade II). Plain chest computed tomography showed multiple pulmonary bullae in both lungs. Thoracoscopic surgery was performed for diagnosis and treatment, and pathology confirmed the diagnosis of thoracic endometriosis. Immediately thereafter, the patient developed recurrent right pneumothorax and right pleural effusion. Although the right pleural effusion improved, massive bloody ascites was observed. Therefore, a contrast-enhanced abdominal radiograph was obtained by injecting amidotrizoic acid at the time of abdominal paracentesis, confirming the communication between the peritoneal and right pleural cavities. Laparoscopic surgery was performed along with surgery for the right pneumothorax. A diaphragmatic lesion was revealed from the thoracic and abdominal sides, and the diaphragm was reinforced on both sides with biological dressing. Pathological examination of the right pneumothorax led to a diagnosis of thoracic endometriosis.
