Reproductive Medicine Unit, ASST Santi Paolo e Carlo, San Paolo University Hospital, Via di Rudinì, 8, 20142, Milan, Italy.
Istituto di Medicina Aerospaziale "A. Mosso", Aeronautica Militare, Milan, Italy.
Reprod Sci. 2021 Apr;28(4):1026-1030. doi: 10.1007/s43032-021-00459-9. Epub 2021 Jan 19.
To describe a rare case of unilateral massive hydrothorax after controlled ovarian stimulation for IVF and to analyze the diagnostic complexities in a patient lacking both risk factors and typical features of ovarian hyperstimulation syndrome (OHSS). We present a case of a 35-year-old woman suffering from primary infertility due to a severe male factor. Admitted to hospital for dyspnea, the patient initially underwent a thoracentesis. Later, due to the recurrence of massive hydrothorax, permanent pleural drainage was placed. Recognized as a severe manifestation of the OHSS, it was treated by pleural drainage, hydration, albumin perfusion, and management of the intercurrent pregnancy, up to improvement in clinical and hematological laboratory parameters and resolution of pleural effusion and respiratory symptoms. A total of 42 l of pleural fluid was drained during the 40 days of hospitalization. Since the pathogenesis of isolated acute hydrothorax in ovarian stimulation probably lies in the presence of anatomical defects of the diaphragm, this may justify that the relationship between this pathology and the OHSS risk factors may be less close. Massive pleural effusion may exceptionally be the only clinical presentation of OHSS. A high index of suspicion is necessary to make the correct diagnosis and to promptly administer treatment.
描述一例在体外受精控制性卵巢刺激后出现单侧大量胸腔积液的罕见病例，并分析一例既缺乏卵巢过度刺激综合征（OHSS）风险因素又缺乏典型特征的患者的诊断复杂性。我们报告了一例 35 岁因严重男性因素导致原发性不孕的患者。该患者因呼吸困难入院，最初接受了胸腔穿刺术。后来，由于大量胸腔积液复发，放置了永久性胸腔引流管。由于其被认为是 OHSS 的严重表现，因此通过胸腔引流、补液、白蛋白灌注以及处理并发妊娠来治疗，直到临床和血液实验室参数改善以及胸腔积液和呼吸症状消退。在住院的 40 天内共排出了 42 升胸腔积液。由于在卵巢刺激中孤立性急性胸腔积液的发病机制可能在于横膈膜解剖缺陷的存在，这可能证明这种病理与 OHSS 风险因素之间的关系可能不太密切。大量胸腔积液可能是 OHSS 的唯一临床表现。需要高度怀疑才能做出正确诊断并及时进行治疗。
