A Case with Severe Endometriosis, Ovarian Hyperstimulation Syndrome, and Isolated Unilateral Pleural Effusion after IVF

Abstract

We present a very rare case of right-sided isolated pleural effusion in a patient with severe endometriosis who, in relation to in vitro fertilization (IVF), developed ovarian hyperstimulation syndrome (OHSS). Earlier laparotomy showed grade IV endometriosis including endometriotic implants of the diaphragm. The patient had no known risk factors for OHSS and only a moderate number of oocytes aspirated. She received, however, repeated hCG injections for luteal support. The patient did not achieve pregnancy but was hospitalized due to pain in the right side of the chest and dyspnoea. A chest computed tomography (CT) showed a pleural effusion on the right side. Total of 1000 ml of pleural fluid was drained after a single thoracentesis. After three days, the symptoms and fluid production ceased. Ascites is a common finding in OHSS, but pleural effusions are rare. Further, isolated pleural effusions have not previously been described in a patient with endometriosis. We suggest that the repeated hCG injections induced effusions from the endometriotic lesions at the diaphragm and as a consequence this patient developed isolated hydrothorax.

Hemothorax after oocyte retrieval in a patient with a history of COVID-19: a case report

“…There is a report of hemothorax in a patient submitted to IVF, which occurred in association with severe endometriosis with involvement of the diaphragm ( Sopa et al ., 2017 ) .…”

“…The presence of spontaneous hemothorax in patients with COVID-19 is a very rare presentation ( Halvorson et al ., 2012 ; Sopa et al ., 2017 ) , and the cases reported occurred during the acute phase of the disease ( Long & Grimaldo, 2021 ) . The association of spontaneous hemothorax with in vitro fertilization (IVF) procedures is rare and has been associated with thoracic endometriosis.…”

A Large Isolated Pleural Effusion in the Right Hemithorax as an Unusual Manifestation Following IVF

“…Being familiar with the underlying risk factors could act as a predictor for OHSS and preventive measures could be taken before its occurrence. Studies have demonstrated that the incidence of moderate-to-severe OHSS occurs in approximately 1%-5% of all women undergoing treatment of infertility [4,5] . A wide spectrum of presentations related to OHSS have been reported in the past, ranging from mild isolated pleural effusions, effusions with accompanying abdominal ascites, to acute respiratory failure and shock [5,6,7] .…”

“…Studies have demonstrated that the incidence of moderate-to-severe OHSS occurs in approximately 1%-5% of all women undergoing treatment of infertility [4,5] . A wide spectrum of presentations related to OHSS have been reported in the past, ranging from mild isolated pleural effusions, effusions with accompanying abdominal ascites, to acute respiratory failure and shock [5,6,7] . I hereby present a rare case of OHSS with an isolated large pleural effusion in the right hemithorax following ongoing cycles of IVF, ultimately resulting in respiratory compromise.…”

Ovarian Hipersitümülasyon Sendromuna Bağlı İzole Plevral Efüzyon Gelişen Olgu Sunumu

“…O zamandan bu yana sadece birkaç vaka raporu yayınlanmıştır ve bu olguların hiçbiri endometriozise sahip değildir (11)(12)(13)(14). Daha önce tarif edildiği gibi, plevral efüzyon esas olarak şiddetli OHSS formlarında ve genel olarak diğer OHSS bulgularıyla birlikte ortaya çıkmaktadır (15). Man ve ark.…”