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\begin{document}

\title{Recurrent chest pain as a rare presentation of extra-pelvic
endometriosis}



\author[1]{Mousa Hussein}%
\author[1]{Mutaz Al bakri}%
\author[2]{Shanima  Ismail}%
\author[1]{Abbas Alabbas}%
\author[1]{Sameer  Alhyassat}%
\affil[1]{Hamad Medical Corporation}%
\affil[2]{Hamad General Hospital}%


\vspace{-1em}



  
  \date{May 26, 2024}


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\selectlanguage{english}
\begin{abstract}
Periodic chest pain, with bloody pleural effusion, should raise the
suspicion of pleural endometriosis as a well-known, but rare condition
in clinical practice.%
\end{abstract}%



\sloppy


\textbf{Recurrent chest pain as a rare presentation of extra-pelvic
endometriosis}

Mousa
Hussein\textsuperscript{1},~Mutaz~Albakri\textsuperscript{1},~Shanima~Ismail~\textsuperscript{1},
Abbas Alabbas\textsuperscript{1},~Samir~Al Hyassat\textsuperscript{2}

\textsuperscript{1~}Hamad Medical Corporation,
Pulmonary~Department,~Doha, Qatar

\textsuperscript{2}~Hamad Medical Corporation,~Laboratory~Medicine. \&
Pathology~Department, Doha, Qatar

\textbf{Corresponding author:\emph{~}}

Mousa Hussein

Email:~mhussein11@hamad.qa

P.O Box~3050,~Doha, Qatar

\subsubsection*{\texorpdfstring{Keywords:\emph{~}}{Keywords:~}}

{\label{keywords}}

Effusion, Pleural disease, Bloody effusion, Thoracoscopy, Endometriosis

\textbf{Key clinical message :}

Periodic chest pain, with bloody pleural effusion, should raise the
suspicion of pleural endometriosis as a well-known, but rare condition
in clinical practice.

\textbf{Clinical Presentation:}

A 34-year-old woman, presented with several~months~history of
right-sided chest pain, that occurred at the same time as her menses
every month. She had no cough, sputum production, fever, or weight loss.
The physical examination was notable for right-sided pleural
effusion.~Laboratory studies were notable for a hemoglobin level of 10.7
g per deciliter, and normal inflammatory markers. Findings on X-ray and
computed tomography of the chest included large right-sided
free-floating effusion with normal lung parenchyma (Figure 1A). The
pleural fluid was~dark-brown~(Chocolate effusion) (Figure 1B), with red
blood cells of 23,375 cells per microliter, and fluid~to serum
hematocrit ratio of 0,63. She underwent medical thoracoscopy which
showed a brown-pigmented implant (Figure 2).~The pleural biopsies
revealed groups of~endometrial stroma like elements that were positive
for CD10, estrogen, and progesterone (Figure~3 ).~The periodic chest
pain, with the dark-brown appearance of the pleural fluid resulting from
invading of the pleural surfaces with endometrial cells that become
active during a menstrual period. The patient was referred to a thoracic
surgeon and gynecologist for definitive management.

\subsection*{Acknowledgments}

{\label{acknowledgments}}

We acknowledge the Qatar National Library for funding the open access
publication of this article. We also acknowledge the Medical Research
Center at Hamad Medical Corporation for their support.

\subsection*{CONFLICT OF INTEREST}

{\label{conflict-of-interest}}

The authors report no conflicts of interest in this work.

\subsection*{AUTHORS' CONTRIBUTIONS}

{\label{authors-contributions}}

Dr Mousa Hussein: served as corresponding author and involved in
manuscript review and submission. Dr Mutaz : served as co-author and
involved in manuscript writing, review, and finalization. Dr. Shanima
and Dr Abbas: involved in manuscript review.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1--(1A)-CT-chest-showing-large-right-sided-free-floating-effusion-(red-arrow)/Figure-1--(1A)-CT-chest-showing-large-right-sided-free-floating-effusion-(red-arrow)}

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\includegraphics[width=0.70\columnwidth]{figures/Figure-2--Image-taken-during-medical-thoracoscopy-,-showing-brown-pigment-area-of-the-parietal-pleura/Figure-2--Image-taken-during-medical-thoracoscopy-,-showing-brown-pigment-area-of-the-parietal-pleura}

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