Thoracic manifestations of ovarian hyperstimulation syndrome

To determine the thoracic manifestations of severe ovarian hyperstimulation syndrome, the major serious complication of induction of superovulation with exogenous gonadotropins.

The authors reviewed the medical records and available images for 771 patients who had received gonadotropins to induce superovulation for in-vitro fertilization and embryo transfer or intrauterine insemination of concentrated sperm. The patients, ranging in age from 28 to 43 years, had been treated between October 1990 and July 1992.

In 22 patients (3%) severe hyperstimulation syndrome was diagnosed clinically and confirmed with ultrasonography. Pleural effusion occurred in five of these (23%), one of whom required thoracentesis. Atelectasis, associated with adult respiratory distress syndrome (ARDS) and internal jugular vein thrombosis, developed in one patient, and ventilation-perfusion mismatch of uncertain cause occurred in another.

Respiratory distress in patients with ovarian hyperstimulation syndrome is most likely due to lung restriction caused by ascites, the large cystic ovaries, or pleural or pericardial effusion. Pulmonary embolism and ARDS may rarely occur. Pulmonary manifestations, not previously well recognized, form an important part of this syndrome, and radiologic input with regard to assessment, monitoring and management are needed.