A 28-Year-Old Woman With Chest Pain, Abdominal Pain, and Right Pleural Effusion

A 28-year-old woman presented to the outpatient setting with right-sided intermittent chest pain for the past 8 months. For the past 3 months, she noticed breathlessness initially on exertion, which had progressed to dyspnea at rest. She also reported intermittent cramping abdominal pain, predominantly in the pelvis, that worsened during each menstrual cycle. She had regular menses and denied the use of any hormonal-based or barrier methods of contraception. She had never smoked. She was married and delivered a child 10 years ago. Two years before this presentation, she had undergone medical termination of pregnancy. A previous Pap smear of the cervix was normal. She denied any history of cough, hemoptysis, vomiting, diarrhea or hematemesis, dyspareunia, or post-coital bleeding. There was no relevant family history.