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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.

Thoracic endometriosis syndrome manifesting as atraumatic haemothorax causing difficult ventilation under general anaesthesia