Peterzan Mark, Reynolds Toby, Dulay Kamaljit, Wooldridge Rachel
Core Medical Training, Barts Health NHS Trust, Newham University Hospital, London, UK.
BMJ Case Rep. 2012 Dec 19;2012:bcr2012007206. doi: 10.1136/bcr-2012-007206.
A 31-year-old woman underwent elective hysteroscopy and laparoscopy for investigation of primary infertility. The procedure was abandoned owing to intraoperative desaturation and reduced right-sided chest movement. Postoperative chest x-ray showed an opacified right hemithorax with tracheal deviation to the left. Retrospectively on direct questioning, she admitted to dry cough, mild dyspnoea and significant weight loss. Diagnostic thoracocentesis and contrast CT scan confirmed heavily blood-stained exudative pleural effusion but were otherwise non-diagnostic. After chest drain insertion, 4.6 litre drained but a hydropneumothorax developed upon drain removal, with no improvement on repeat drain insertion. Right video-assisted thoracic surgery was performed, converted to thoracotomy, with repair of diaphragmatic fenestrations, pleurectomy and decortication of trapped lung undertaken. Histological examination of samples of pleura and lung cortex was pathognomic of endometriosis. She was started on norethisterone with no recurrence to date.
一名31岁女性因原发性不孕症接受了选择性宫腔镜检查和腹腔镜检查。手术因术中出现低氧血症和右侧胸部活动减少而中止。术后胸部X光显示右半胸模糊，气管向左偏移。经直接询问后回顾，她承认有干咳、轻度呼吸困难和明显体重减轻。诊断性胸腔穿刺和增强CT扫描证实为血性渗出性胸腔积液，但未得出其他诊断结果。插入胸腔引流管后，引出4.6升液体，但拔除引流管后出现液气胸，再次插入引流管后情况未改善。遂进行了右侧电视辅助胸腔手术，后转为开胸手术，修复了膈肌开窗，进行了胸膜切除术和被困肺的纤维板剥脱术。胸膜和肺皮质样本的组织学检查显示为子宫内膜异位症的典型表现。她开始服用炔诺酮，至今未复发。
