CASE REPORT: SPONTANEOUS HEMOTHORAX- A RARE PRESENTATION OF ECTOPIC PREGNANCY

Abstract

Common presenting symptoms of an ectopic pregnancy are pain abdomen, amenorrhea, vaginal bleeding and syncope some times. Although it is typically confined to pelvis, rare manifestations involving the thorax, abdomen or pericardium have been documented(3-6). We are reporting a case of ruptured ectopic pregnancy presenting mainly as hemothorax. A 27 Years old female patient P2L2A2, Previous 2 LSCS not tubal ligated with history of oligomenorrhea, initially complained of pain abdomen, vomiting and syncopal attack for which she received some pain killer and IV fluids at some local hospital. Over next 3 to 4 days, she complained of increasing breathlessness and cough. Her chest X- RAY (figure- 1) and chest CECT was done that showed right side massive pleural effusion with collapse of right lung and left side shift of trachea and mediastinum. In view of these findings ICT was inserted that drained 2 liters of dark hemorrhagic fluid. CECT abdomen showed an irregular mildly enhancing, solid, cystic lesion of size 7.5X 4.8X 5.6 cm in right adnexal region with mild to moderate fluid collection in peritoneal cavity. UPT was positive, Serum beta HCG was 1286 m IU/ml. Laparotomy was done in view of ruptured ectopic pregnancy with hemoperitoneum with associated hemothorax. Intraoperatively approx. 1500cc hemoperitoneum (Figure-4) found. In postop period ICT Drain fluid changed to serous and drained only 150cc in next 24 hrs (Figure-5). This is a rare case of spontaneous hemothorax precipitated by hemoperitoneum secondary to ruptured tubal ectopic pregnancy. There have been few case reports of hemothorax associated with ectopic pregnancy in literature.