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Solsona Í, Peralta S, Barral Y, Fàbregues F, Giménez-Bonafé P. Unusual ovarian hyperstimulation syndrome presentation: Pleural effusion without ascites. A case report. World J Clin Cases 2025; 13:100028. [PMID: 40094114 PMCID: PMC11670015 DOI: 10.12998/wjcc.v13.i8.100028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 09/24/2024] [Accepted: 10/16/2024] [Indexed: 12/04/2024] Open
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation. This case report highlights a unique manifestation of OHSS involving pleural effusion (PE) in a patient without identifiable risk factors. CASE SUMMARY A 39-year-old woman who underwent controlled ovarian hyperstimulation for an in vitro fertilization (IVF) cycle experienced dyspnea on the eleventh day of post oocyte retrieval. The diagnosis was severe OHSS with a unique manifestation of PE without ascites. Clinical management involved fluid balance and treatment with albumin, furosemide, thromboembolic prophylaxis, and thoracentesis. A continued drainage of the pleural cavity was performed. The patient had a favorable outcome, and a dichorionic diamniotic gestation passed without incident. CONCLUSION OHSS and its potential complications can include respiratory distress and PE, as well as thromboembolic disorders.
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Affiliation(s)
- Íngrid Solsona
- Department of Physiological Sciences, Physiology Unit, Faculty of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, IDIBELL, Barcelona 08907, Catalonia, Spain
| | - Sara Peralta
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Faculty of Medicine, University of Barcelona, Barcelona 08036, Catalonia, Spain
| | - Yasmina Barral
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Faculty of Medicine, University of Barcelona, Barcelona 08036, Catalonia, Spain
| | - Francisco Fàbregues
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Faculty of Medicine, University of Barcelona, Barcelona 08036, Catalonia, Spain
| | - Pepita Giménez-Bonafé
- Department of Physiological Sciences, Faculty of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, IDIBELL, L'Hospitalet de Llobregat 08907, Barcelona, Spain
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Hsu JC, Huang KL, Tsai NC. Bilateral massive bloody pleural effusions as a rare presentation of ovarian hyperstimulation syndrome: A case report and literature review. Taiwan J Obstet Gynecol 2025; 64:348-352. [PMID: 40049824 DOI: 10.1016/j.tjog.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 05/13/2025] Open
Abstract
OBJECTIVE Pulmonary complications related to ovarian hyperstimulation syndrome (OHSS) can occur following assisted reproductive technologies (ART). However, bloody pleural effusions are exceedingly rare. We present a case of a patient who underwent ART treatment and developed OHSS, subsequently experiencing bilateral massive bloody pleural effusion. CASE REPORT A 32-year-old woman with primary infertility underwent in vitro fertilization (IVF) treatment. After oocyte retrieval, she presented to the emergency department with a chief complaint of abdominal distention and chest pain. Ovarian hyperstimulation syndrome, complicated by bilateral massive bloody pleural effusion (exudative), was diagnosed. Her d-dimer was initially elevated, then decreased gradually, and her shortness of breath improved. The patient was discharged without any clinical sequelae. CONCLUSION OHSS can lead to life-threatening complications such as pleural effusion and, in rare cases, bloody pleural effusion. Following oocyte retrieval, an elevated d-dimer level has no specific diagnostic role and should only be used to rule out thromboembolic events.
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Affiliation(s)
- Jen-Chi Hsu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kaohsiung Chang Gung Memorial Hospital Medical Education Department, Taiwan
| | - Kun-Long Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ni-Chin Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kaohsiung Chang Gung Memorial Hospital Medical Education Department, Taiwan; Department of Obstetrics and Gynecology, Pingtung Christian Hospital, Taiwan.
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Ferreiro L, Toubes ME, Rodríguez-Núñez N, Valdés L. Benign obstetric and gynaecological diseases associated with pleural effusion: a narrative review. Breathe (Sheff) 2025; 21:240238. [PMID: 40007527 PMCID: PMC11851138 DOI: 10.1183/20734735.0238-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 10/29/2024] [Indexed: 02/27/2025] Open
Abstract
Certain obstetric and gynaecological diseases are associated with pleural effusion, including benign peripartum pleural effusion, endometriosis, ovarian hyperstimulation syndrome and Meigs syndrome. This review provides a comprehensive and detailed overview of this group of rare diseases. A thorough understanding of their unique characteristics is required to ensure early identification, correct diagnosis and appropriate management.
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Affiliation(s)
- Lucía Ferreiro
- Pulmonology Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - María E. Toubes
- Pulmonology Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Nuria Rodríguez-Núñez
- Pulmonology Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Luis Valdés
- Pulmonology Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Department of Medicine, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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Dumančić S, Mikuš M, Palčić Z, Habek D, Tešanović M, Mimica MD, Marušić J. Severe Early-Onset Intrahepatic Cholestasis of Pregnancy Following Ovarian Hyperstimulation Syndrome with Pulmonary Presentation after In Vitro Fertilization: Case Report and Systematic Review of Case Reports. Life (Basel) 2024; 14:129. [PMID: 38255744 PMCID: PMC10820620 DOI: 10.3390/life14010129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/03/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disease, usually presented in the third trimester with pruritus, elevated transaminase, and serum total bile acids. Evidence shows that it can be developed in the first trimester, more commonly after in vitro fertilization (IVF) procedures, with the presence of ovarian hyperstimulation syndrome (OHSS). METHODS A literature search was conducted in the PubMed/MEDLINE database of case reports/studies reporting early-onset ICP in spontaneous and IVF pregnancies published until July 2023. RESULTS Thirty articles on early-onset ICP were included in the review analysis, with 19 patients who developed ICP in spontaneous pregnancy and 15 patients who developed ICP in IVF pregnancies with or without OHSS. Cases of 1st and 2nd trimester ICP in terms of "early-onset" ICP were pooled to gather additional findings. CONCLUSIONS Proper monitoring should be applied even before expected pregnancy and during IVF procedures in patients with known risk factors for OHSS and ICP development (patient and family history), with proper progesterone supplementation dosage and genetic testing in case of ICP recurrence.
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Affiliation(s)
- Stipe Dumančić
- Department of Obstetrics and Gynecology, Clinical Hospital Center Split, 21 000 Split, Croatia; (S.D.); (M.D.M.)
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, 10 000 Zagreb, Croatia
| | - Zdenka Palčić
- Department of Obstetrics and Gynecology, Clinical Hospital Center Split, 21 000 Split, Croatia; (S.D.); (M.D.M.)
| | - Dubravko Habek
- School of Medicine, Catholic University of Croatia, Ilica 242, 10 000 Zagreb, Croatia;
| | - Mara Tešanović
- Department of Obstetrics and Gynecology, General Hospital Dubrovnik, 20 000 Dubrovnik, Croatia;
| | - Marko Dražen Mimica
- Department of Obstetrics and Gynecology, Clinical Hospital Center Split, 21 000 Split, Croatia; (S.D.); (M.D.M.)
| | - Jelena Marušić
- Department of Obstetrics and Gynecology, Clinical Hospital Center Split, 21 000 Split, Croatia; (S.D.); (M.D.M.)
- School of Medicine, University of Split, Soltanska 2, 21 000 Split, Croatia
- University Department of Health Studies, University of Split, R. Boskovica 35, 21 000 Split, Croatia
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Khaja M, Powell S, Kandhi S, Stastka P, Yordanka DS, Ronderos DM. A Case of Severe Ovarian Hyperstimulation Syndrome Causing Pleural Effusion. Cureus 2022; 14:e28804. [PMID: 36225428 PMCID: PMC9534519 DOI: 10.7759/cureus.28804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
Abstract
Ovarian hyperstimulation syndrome is one of the complications of treating infertility by ovarian stimulation. As a result of the stimulation, there is a shift of serum from the intravascular space to the third space, leading to complications like ascites and pleural effusion. Here we present a case of a 29-year-old female with polycystic ovarian syndrome who was being treated for infertility using ovarian stimulation agents for in-vitro fertilization. After egg retrieval, the patient complained of shortness of breath and was found to have right-sided pleural effusion. Her symptoms were eventually relieved following an ultrasound-guided diagnostic and therapeutic thoracentesis. Upon discharge, a repeat chest radiograph in the pulmonary clinic showed no pleural effusion. In conclusion, although severe complications like pleural effusion from ovarian stimulation are rare, the physician should be able to recognize this phenomenon to prevent any further deterioration of the patient.
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Rahal D, Kozlowski IF, Rosa VBD, Schuffner A. Hemothorax after oocyte retrieval in a patient with a history of COVID-19: a case report. JBRA Assist Reprod 2021; 25:647-649. [PMID: 34415132 PMCID: PMC8489828 DOI: 10.5935/1518-0557.20210043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Spontaneous hemothorax is a rare disorder characterized by pleural fluid hematocrit greater than 50% of the peripheral blood hematocrit without natural or iatrogenic trauma to the lungs or pleural space. Since the first case of COVID-19, more than 85 million cases have been confirmed and most patients have sustained symptoms after more than six months of acute infection. This paper reports the case of a 38-year-old woman without signs of endometriosis and a history of COVID-19 infection who developed spontaneous hemothorax after oocyte retrieval. Three months before undergoing assisted reproductive technology (ART) treatment, the patient had a symptomatic COVID-19 infection with a negative PCR test and a positive IgG test four weeks after the onset of symptoms. Controlled ovarian stimulation and oocyte retrieval were conducted uneventfully. Two hours after oocyte retrieval, the patient developed nausea and mild hypogastric pain. Ten hours after the procedure, the patient went to the emergency department with abdominal pain. Chest computed tomography scans revealed moderate right pleural effusion and laminar left pleural effusion. Since the patient had respiratory symptoms, the choice was made to drain the pleural fluid. Fluid analysis confirmed the patient had right hemothorax (400 mL). After drainage, the patient's clinical and imaging signs improved gradually without complications. The patient was asymptomatic one week after the procedure.
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Affiliation(s)
- Danilo Rahal
- Conceber Centro de Medicina Reprodutiva, Curitiba, Paraná, Brazil
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Vidal A, Wachter C, Kohl Schwartz A, Dhakal C. A rare presentation of isolated right-sided pleural effusion in the context of ovarian hyperstimulation syndrome: A case report. Case Rep Womens Health 2021; 32:e00347. [PMID: 34401398 PMCID: PMC8350452 DOI: 10.1016/j.crwh.2021.e00347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/27/2022] Open
Abstract
An isolated pleural effusion as the sole manifestation of early ovarian hyperstimulation syndrome (OHSS) is rare. A 38-year-old woman who had undergone in vitro fertilization presented with OHSS. Six days after transvaginal oocyte pickup, she presented with only an isolated right-sided pleural effusion and restricted respiratory capacity. A thoracentesis was successfull. Clinicians must be aware of unilateral pleural effusion, with a higher incidence on the right side, as a single-symptom presentation of OHSS. The case reported here illustrates the diversity and severity of OHSS.
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Affiliation(s)
- Angela Vidal
- Division of Gynecological Endocrinology and Reproductive Medicine, Lucerne Cantonal Hospital, Switzerland
| | - Christiane Wachter
- Division of Gynecological Endocrinology and Reproductive Medicine, Lucerne Cantonal Hospital, Switzerland
| | - Alexandra Kohl Schwartz
- Division of Gynecological Endocrinology and Reproductive Medicine, Lucerne Cantonal Hospital, Switzerland
| | - Carolin Dhakal
- Division of Gynecological Endocrinology and Reproductive Medicine, Lucerne Cantonal Hospital, Switzerland
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Pellerin M, Fischbach E, Lemardeley G, Rongières C, Garbin O, Pirrello O. [Ovarian stimulation: Complications caused by thoracic endometriosis]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:400-403. [PMID: 32006742 DOI: 10.1016/j.gofs.2020.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Indexed: 06/10/2023]
Affiliation(s)
- M Pellerin
- Service de gynécologie, centre médico-chirurgical et obstétrical - hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France.
| | - E Fischbach
- Service de gynécologie, centre médico-chirurgical et obstétrical - hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - G Lemardeley
- Pôle sécurité - qualité, agence de biomédecine, direction médicale et scientifique, 1, avenue du Stade de France, 93212 Saint-Denis, Réunion
| | - C Rongières
- Service d'assistance médicale à la procréation, centre médico-chirurgical et obstétrical - hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - O Garbin
- Service de chirurgie gynécologique, centre médico-chirurgical et obstétrical - hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - O Pirrello
- Service d'assistance médicale à la procréation, centre médico-chirurgical et obstétrical - hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
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Sen S, Yong TT, Yu SL, Rajesh H. Isolated Unilateral Pleural Effusion Without Ascites in Late Onset Ovarian Hyperstimulation Syndrome: A Case Report and Review of Literature. FERTILITY & REPRODUCTION 2019. [DOI: 10.1142/s2661318219300058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Isolated pleural effusion is a rare presentation of severe OHSS. Two to four percent of women of reproductive age have subclinical hypothyroidism which is an uncommon association of late onset iatrogenic OHSS. This report describes an unusual patient with isolated unilateral pleural effusion and subclinical hypothyroidism as the only manifestation of late onset OHSS in a singleton pregnancy following in vitro fertilization (IVF). We have summarized current literature related to isolated pleural effusion in late OHSS and evaluated its pathophysiology and treatment options. Albumin infusion may be considered as a plasma expander whenever there is a planned third space drainage. Thyroid profile test in asymptomatic patients planning IVF will help to identify subclinical hypothyroidism. OHSS is a self-limiting condition and a timely diagnosis with aggressive management can be lifesaving.
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Affiliation(s)
- Shashwati Sen
- Centre for Assisted Reproduction, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Tze Tein Yong
- Centre for Assisted Reproduction, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Su Ling Yu
- Centre for Assisted Reproduction, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Hemashree Rajesh
- Centre for Assisted Reproduction, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
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