Hydrothorax, Ascites, and Pelvic Endometriosis

Report of a Case

In summary, this 32 year old patient had had prolonged symptoms of endometriosis, temporarily improved by subtotal hysterectomy and removal of the left tube and ovary in 1944, and by radium implantation in the cervix in 1945. At laparotomy on July 11, 1947, the other ovary (which showed endometrial implants) was removed. Four days after operation the patient developed a severe pleural effusion persisting for six weeks and requiring 20 thoracenteses. Ascites appeared a month after operation and one paracentesis was performed. Effusion into the peritoneal and right pleural cavities ceased abruptly late in September, 1947, six weeks after laparotomy, and has not recurred.

The basis for sudden onset and disappearance of these effusions is not known. A tuberculous etiology is quite unlikely in view of the negative tuberculin tests. The clinical findings do not suggest cardiac decompensation, hepatic or renal failure, or hypoproteinemia. Metastatic malignancy in the thorax and abdomen can also be ruled out. It is true that two cases with endometrial metastases to the lungs have been reported, but ascites and pleural effusion were not present in these patients. Our case is not presented as an example of Meigs syndrome, but the similarity to reported instances of this condition is striking enough.