Massive pleural endometriosis

We present a patient who was referred to our thoracic surgical service with a massive, loculated right pleural effusion accompanied by significant ascites. Thoracotomy and decortication were required and pleural biopsy led to a diagnosis of endometriosis. Aggressive medical therapy was subsequently initiated but hysterectomy with bilateral oophorectomy was required due to poor symptom control and the inability to rule out a neoplastic process. There are less than 15 reported cases of endometriosis presenting with both pleural effusion and ascites. Thoracic surgeons presented with such a scenario should be cognizant of this pathological entity.