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Diagnostic Complexities in a Case of Ovarian Hyperstimulation Syndrome Presented Solely as a Unilateral Massive Hydrothorax. Reprod Sci 2021; 28:1026-1030. [PMID: 33469877 DOI: 10.1007/s43032-021-00459-9] [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: 09/21/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
To describe a rare case of unilateral massive hydrothorax after controlled ovarian stimulation for IVF and to analyze the diagnostic complexities in a patient lacking both risk factors and typical features of ovarian hyperstimulation syndrome (OHSS). We present a case of a 35-year-old woman suffering from primary infertility due to a severe male factor. Admitted to hospital for dyspnea, the patient initially underwent a thoracentesis. Later, due to the recurrence of massive hydrothorax, permanent pleural drainage was placed. Recognized as a severe manifestation of the OHSS, it was treated by pleural drainage, hydration, albumin perfusion, and management of the intercurrent pregnancy, up to improvement in clinical and hematological laboratory parameters and resolution of pleural effusion and respiratory symptoms. A total of 42 l of pleural fluid was drained during the 40 days of hospitalization. Since the pathogenesis of isolated acute hydrothorax in ovarian stimulation probably lies in the presence of anatomical defects of the diaphragm, this may justify that the relationship between this pathology and the OHSS risk factors may be less close. Massive pleural effusion may exceptionally be the only clinical presentation of OHSS. A high index of suspicion is necessary to make the correct diagnosis and to promptly administer treatment.
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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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Irani M, Robles A, Gunnala V, Chung P, Rosenwaks Z. Unilateral pleural effusion as the sole clinical presentation of severe ovarian hyperstimulation syndrome: a systematic review. Gynecol Endocrinol 2018; 34:92-99. [PMID: 29063807 DOI: 10.1080/09513590.2017.1390738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The pathophysiology of isolated pleural effusion in ovarian hyperstimulation syndrome (OHSS) is not well defined. The objective of the current review is to delineate the pathophysiology, risk factors, preventive measures, and therapeutic options of isolated pleural effusion in severe OHSS. Major databases were searched until June 2016. Studies evaluating women who presented with pleural effusion as the sole extra-ovarian manifestation of severe OHSS were included. Data were extracted from 24 articles encompassing 30 reported cases. Values were expressed as mean ± SEM. Patients were young (31.5 ± 0.8 years old) and 29.1% of them were diagnosed with polycystic ovary syndrome. All the patients received human chorionic gonadotropin to trigger oocyte maturation. Estradiol level was 3110 ± 330 pg/mL on the day of the ovulatory trigger. Dyspnea was the presenting symptom in 86.6% of the patients. Pleural effusion was predominantly on the right side (80%). Ninety percent of the patients underwent thoracentesis (4332 ± 769 mL): 66.7% exudate and 33.3% transudate. Fluid initially accumulates in the peritoneal cavity then enters the pleural space due to the pressure gradient through the thoracic duct and diaphragmatic defects, which are more common on the right side. The risk factors, prevention, and management, which are also discussed in this review, are similar to those of severe OHSS.
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Affiliation(s)
- Mohamad Irani
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA
| | - Alex Robles
- b Department of Obstetrics and Gynecology , Weill Cornell Medicine , New York , NY , USA
| | - Vinay Gunnala
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA
| | - Pak Chung
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA
| | - Zev Rosenwaks
- a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA
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Sharma S, Gautam PL, Singh T, Sobti RS, Sandhu JS, Puri S. Critical Ovarian Hyperstimulation Syndrome and Management. J Obstet Gynaecol India 2015; 66:131-3. [PMID: 27046970 DOI: 10.1007/s13224-015-0715-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/18/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Shruti Sharma
- Department of Critical Care, Dayanand Medical College and Hospital, Ludhiana, Punjab India
| | - Parshotam Lal Gautam
- Department of Critical Care, Dayanand Medical College and Hospital, Ludhiana, Punjab India
| | - Tarandeep Singh
- Department of Critical Care, Dayanand Medical College and Hospital, Ludhiana, Punjab India
| | - Rabinder Singh Sobti
- Department of Critical Care, Dayanand Medical College and Hospital, Ludhiana, Punjab India
| | | | - Suman Puri
- Department of Obstetrics and Gynaecology, Dayanand Medical College and Hospital, Ludhiana, Punjab India
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Abstract
Pleural effusions in ovarian hyperstimulation syndrome, whether transudative or exudative, can occur in up to 30% of cases. This disorder is always reversible but may have various clinical presentations and degrees of severity. Although assessing for risk factors to predict clinical severity is helpful, it is rare for ovarian hyperstimulation syndrome to present as a massive pleural effusion requiring emergent intervention. In this study, such a case is reported.
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Junqueira JJM, Bammann RH, Terra RM, Castro ACP, Ishy A, Fernandez A. Pleural effusion following ovarian hyperstimulation. J Bras Pneumol 2012; 38:400-3. [PMID: 22782612 DOI: 10.1590/s1806-37132012000300017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 10/18/2010] [Indexed: 11/22/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that occurs in the luteal phase of an induced hormonal cycle. In most cases, the symptoms are self-limited and spontaneous regression occurs. However, severe cases are typically accompanied by acute respiratory distress. The objective of the present study was to describe the clinical presentation, treatment, and outcome of pleural effusion associated with OHSS in three patients undergoing in vitro fertilization. The patients ranged in age from 27 to 33 years. The onset of symptomatic pleural effusion (bilateral in all cases) occurred, on average, 43 days (range, 27-60 days) after initiation of hormone therapy for ovulation induction. All three patients required hospitalization for massive fluid resuscitation, and two required noninvasive mechanical ventilation. Although all three patients initially underwent thoracentesis, early recurrence of symptoms and pleural effusion prompted the use of drainage with a pigtail catheter. Despite the high output from the pleural drain (mean, 1,000 mL/day in the first week) and prolonged drainage (for 9-22 days), the outcomes were excellent: all three patients were discharged from hospital. Although pleural effusion secondary to OHSS is probably underdiagnosed, the associated morbidity should not be underestimated, especially because it affects potentially pregnant patients. In this study, early diagnosis and appropriate supportive measures yielded favorable results, limiting the surgical approach to adequate pleural drainage.
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Halvorson SAC, Ricker MA, Barker AF, Patton PE, Harrison RA, Hunter AJ. Thoracic endometriosis unmasked by ovarian hyperstimulation for in vitro fertilization. J Gen Intern Med 2012; 27:603-7. [PMID: 22234445 PMCID: PMC3326110 DOI: 10.1007/s11606-011-1959-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 08/02/2011] [Accepted: 11/22/2011] [Indexed: 10/14/2022]
Abstract
Thoracic endometriosis syndrome is a well-described, rare manifestation of endometriosis. We present a case of a 35-year old woman undergoing controlled ovarian stimulation prior to in vitro fertilization (IVF) who developed bilateral hemorrhagic pleural effusions. She was initially diagnosed with ovarian hyperstimulation syndrome, a complication of infertility therapy; however, she was later found to have occult thoracic endometriosis. We describe ovarian hyperstimulation syndrome and review the manifestations of thoracic endometriosis syndrome. Although endometriosis is a hormone-dependent disease, the rate of IVF complications related to endometriosis is low.
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Affiliation(s)
- Stephanie A C Halvorson
- OHSU Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd BTE-119, Portland, Oregon 97239, USA.
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Symptomatic isolated pleural effusion as an atypical presentation of ovarian hyperstimulation syndrome. Case Rep Obstet Gynecol 2011; 2011:967849. [PMID: 22567522 PMCID: PMC3335556 DOI: 10.1155/2011/967849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 06/14/2011] [Indexed: 11/17/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) presents in ~33% of ovarian stimulation cycles with clinical manifestations varying from mild to severe. Its pathogenesis is unknown. Pleural effusion is reported in ~10% of severe OHSS cases and is usually associated with marked ascites. The isolated finding of pleural effusions without ascites, as the main presenting symptom of OHSS is not frequently reported and its pathogenesis is also unknown. We describe two unusual cases of OHSS where dyspnea secondary to unilateral pleural effusion was the only presenting symptom. By reporting our experience, we would like to heighten physicians' awareness in detecting these cases early, as it is our belief that the incidence of pleural effusion in the absence of most commonly recognized risk factors for OHSS may be underestimated and may significantly compromise the health of the patient if treatment is not initiated in a reasonable amount of time.
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Gupta S, Sathya B, Padhy N, Kundavi S, Thomas BE, Varma TR. Isolated bilateral pleural effusion as the sole manifestation of late onset ovarian hyperstimulation syndrome. J Hum Reprod Sci 2009; 2:83-6. [PMID: 19881155 PMCID: PMC2800934 DOI: 10.4103/0974-1208.57229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To report a case of late onset ovarian hyperstimulation with bilateral pleural effusion and respiratory distress as the sole manifestation after embryo transfer.
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Affiliation(s)
- Shalu Gupta
- Department of Obstetric and Gynaecology, Reproductive Medicine, Institute of Reproductive Medicine, Madras Medical Mission, J J Nagar, Chennai, Tamil Nadu, India
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Beji O, Brahmi N, Thabet H, Mokline A, Abidi N, Blel Y, Kouraichi N, Amamou M. Compressive pleural effusion after ovarian hyperstimulation syndrome—a case report and review. Fertil Steril 2008; 89:1826.e1-3. [PMID: 17761176 DOI: 10.1016/j.fertnstert.2007.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 06/05/2007] [Accepted: 06/05/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To report a case of early onset ovarian hyperstimulation with massive pleural effusion and respiratory failure before IVF. DESIGN Case report. SETTING University teaching intensive care unit. PATIENT(S) A 26-year-old healthy woman with an unexplained infertility transferred to the intensive care unit on day 4 after hCG injection for early severe presentation of ovarian hyperstimulation syndrome with massive compressive pleural effusion before she underwent embryo transfer. INTERVENTION(S) Mechanical ventilation, thoracocentesis. MAIN OUTCOME MEASURE(S) Resolution of symptoms/stopping of embryos transfer. RESULT(S) Drainage of 5,300 mL of sterile exudative pleural fluid for a period of 48 hours, which permitted resolution of symptoms and allowed mechanical weaning. The IVF procedure was stopped. CONCLUSION(S) This case described is unusual in that the patient presented with early massive pleural effusion on day 4 after hCG injection and before embryo transfer. This is much earlier than in any case report elsewhere.
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Affiliation(s)
- Olfa Beji
- Department of Intensive Care Medicine, CAMU (Centre d'Assistance Médicale Urgente), Tunis, Tunisia
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Khairy M, El-Toukhy T, Emovon E, Khalaf Y. Hydrothorax as the sole manifestation of ovarian hyperstimulation syndrome: unusual case and literature review. Reprod Biomed Online 2007; 14:715-7. [PMID: 17579985 DOI: 10.1016/s1472-6483(10)60673-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An unusual case of a unilateral massive hydrothorax after IVF treatment is reported in a 41-year-old patient, which developed as the only manifestation of ovarian hyperstimulation syndrome. The literature on such rare presentation is also reviewed to highlight its diagnostic features and prognosis.
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Affiliation(s)
- Mohamed Khairy
- Assisted Conception Unit, 4th Floor Thomas Guy House, Guy's and St Thomas' NHS Foundation Trust, St Thomas Street, London SE1 9RT, UK
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Tang HH, Tsai YC, Kang CY, Chung MT, Loo TC, Huang KF. Atypical Ovarian Hyperstimulation Syndrome with Isolated Pleural Effusion but Without Ascites or Hemoconcentration. Taiwan J Obstet Gynecol 2007; 46:180-2. [PMID: 17638630 DOI: 10.1016/s1028-4559(07)60016-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Murray A, Rombauts L. Unilateral pleural effusion as the main presentation of "early onset" severe ovarian hyperstimulation syndrome. Fertil Steril 2004; 81:1127-9. [PMID: 15066475 DOI: 10.1016/j.fertnstert.2003.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2003] [Revised: 12/03/2003] [Accepted: 12/03/2003] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To report a case of severe early onset ovarian hyperstimulation syndrome with unilateral pleural effusion and little ascites as the main presenting clinical signs. DESIGN Case report. SETTING University affiliated teaching hospital and in vitro fertilization (IVF) clinic. PATIENT(S) A 33-year-old woman known to have bilateral polycystic ovaries underwent IVF and became pregnant. INTERVENTION(S) Pleuracentesis. MAIN OUTCOME MEASURE(S) Resolution of symptoms, pregnancy outcome. RESULT(S) A total of 4,200 mL of pleural fluid was drained from the right hemithorax. Complete resolution of symptoms did not occur until 16 weeks' gestation. The pregnancy progressed normally until 27 weeks when spontaneous preterm labor resulted in a vaginal delivery of a live female infant weighing 880 grams. CONCLUSION(S) This case described is unusual in that the patient presented with significant right-sided pleural effusions on day 2 after embryo transfer and continued to be symptomatic until 16 weeks' gestation. This is much earlier than any previously described case report of isolated unilateral pleural effusion associated with ovarian hyperstimulation syndrome.
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Affiliation(s)
- Andrew Murray
- Department of Obstetrics and Gynaecology, Wellington School of Medicine, Wellington South, New Zealand
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Abstract
In a pregnant woman who presents with acute pelvic pain and an adnexal mass, pregnancy-related etiologies, such as ectopic pregnancy or ovarian torsion, are typically the first diagnoses to be considered. Many other causes of pelvic pain associated with an adnexal mass can occur in pregnant patients, however. Some causes are benign and others require urgent management and treatment. Clinical presentation and physical examination can be misleading in pregnancy. The location of pain may be atypical for the pathologic entity, the pain may be muted, and in the case of infection, fever and leukocytosis can be absent. US examination is a safe and effective method for evaluating these patients. Sonographic characterization of adnexal masses may make a definitive diagnosis or focus the differential, which allows for prompt and appropriate treatment of patients.
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Affiliation(s)
- Emily M Webb
- Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
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Abstract
The authors report a patient with ovarian hyperstimulation syndrome who had findings on chest radiographic. Bilateral pleural effusions and bibasilar partial atelectasis were the preeminent features. The pleural effusions resulted from accompanying ascites. Ovarian hyperstimulation syndrome occurs in the postovulatory or post-oocyte retrieval phase, 5 to 7 days after administration of human chorionic gonadotropin. Awareness of imaging findings should facilitate the diagnosis of this syndrome.
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Affiliation(s)
- Matthew McNeary
- Department of Radiology, University of California, San Diego, USA
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Akdemir R, Uyan C, Emiroglu Y. Acute myocardial infarction secondary thrombosis associated with ovarial hyperstimulation syndrome. Int J Cardiol 2002; 83:187-9. [PMID: 12007695 DOI: 10.1016/s0167-5273(02)00044-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complication of controlled ovarian stimulation. Cerebral infarction, myocardial infarction, death and vascular thrombotic events associated with OHSS had been reported. We report a case of a patient with myocardial infarction associated with OHSS.
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Diego Roza C, Carazo Fernández L, Escudero Bueno C. [Ovarian hyperstimulation syndrome as the cause of pleural effusion: a case report]. Arch Bronconeumol 2002; 38:155-6. [PMID: 11900698 DOI: 10.1016/s0300-2896(02)75178-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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