Unusual cause of pleural effusion: ovarian hyperstimulation syndrome

Extract

Case history

A 29-year-old woman presented to emergency department with dyspnea and non-productive cough. Other than infertility, she had no medical history. She received human chorionic gonadotropin (HCG) 10 days before presentation, with oocyte retrieval 3 days after. Chest examination revealed dullness to percussion and absent breath sounds over the lower one-third of right hemithorax. Complete blood count, comprehensive metabolic panel and D-Dimer were unremarkable. Chest X ray and computed tomography of the pulmonary arteries (Figure 1A) demonstrated moderate right and small left pleural effusions but no evidence of pulmonary embolism (PE). Due to history of recent in vitro fertilization (IVF) procedure, transvaginal ultrasound (Figure 1B) was requested and revealed bilaterally enlarged ovaries. Estradiol was elevated to 5545 pg/ml (normal < 350) Thoracentesis was performed and 1050 ml was removed, with a marked resolution of her symptoms. She required five more sequential therapeutic thoracenteses. A total of 4 l of pleural fluid was removed. She was discharged after spending 4 days in the hospital, with a 4-week follow-up chest radiograph showed complete resolution of pleural effusion.