Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature

Bozdag, Gurkan; Tanacan, Atakan; Mumusoglu, Sezcan; Turan, Volkan

doi:10.4274/tjod.galenos.2019.89656

Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature

Sezcan MÜMÜŞOĞLU, (Hacettepe Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Ankara, Türkiye)

Atakan TANACAN, (Hacettepe Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Ankara, Türkiye)

Volkan TURAN, (Üsküdar Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, İstanbul, Türkiye)

Gürkan BOZDAĞ (Hacettepe Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Ankara, Türkiye)

Turkish Journal of Obstetrics and Gynecology

2 0

Yıl: 2020 Cilt: 17 Sayı: 1 Sayfa Aralığı: 65 - 72 Metin Dili: İngilizce DOI: 10.4274/tjod.galenos.2019.89656 İndeks Tarihi: 27-06-2021

Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature

Öz:

Although hydrothorax may accompany abdominal ascites in women with severe ovarian hyperstimulation syndrome (OHSS), there are few cases reported with isolated pleural effusion. Herein, we report two patients with isolated hydrothorax without any significant abdominal fluid following infertilitytreatment, along with a systematic review of the literature to describe risk factors for this rare entity. Two women with isolated pleural effusion withoutsignificant abdominal ascites were reported. The available literature was screened from Ovid-SP and PubMed to review OHSS cases with isolated hydrothorax. Two women aged 28 and 31 years were admitted to hospital with chest pain, tachypnea, and tachycardia after infertility treatment. They had right pleural effusion without abdominal fluid and the symptoms relieved after thoracentesis. Similar to our cases, we identified 24 case reports (n=41 women) in the literature according to eligible criteria. On the day of triggering, estradiol (E2) level was <4000 pg/mL in 81% of reported cases and hematocrit (HCT) was <45% in 44% of cases at the time of diagnosis. Isolated hydrothorax is an unpredictable event, which may even complicate women with low E2 levels or HCT concentrations. Physicians should keep in mind the possibility of isolated hydrothorax when respiratory symptoms are significant but abdominalascites is not evident.

Anahtar Kelime:

İzole tek taraflı hidrotoraks şeklinde bulgu veren ovaryan hiperstimülasyon sendromu: İki olgunun takdimi ve literatürün sistematik olarak gözden geçirilmesi

Öz:

Siddetli ovarian hiper-stimulasyon sendromu (OHSS) olan hastalarda abdominal asite hidrotoraksın da eşlik etmesi karşılaşılan bir durumdur, ancak literatürde izole hidrotoraks ile başvuran sadece birkaç olgu bildirilmiştir. Bu yazıda infertilite tedavisini takiben batında belirgin asit olmadan izole hidrotoraksı olan iki hastayı rapor etmeyi ve bu nadir durum için risk faktörlerini tanımlayabilmek için sistematik bir derleme yapmayı amaçladık. Belirgin asiti olmadan izole sağ taraf hidrotoraksı olan iki kadın rapor edildi. Izole hidrotoraks ile başvuran OHSS olgularını gözden geçirmek için Ovid-SP ve PubMed veri tabanlarında literatür taraması yapıldı. İnfertilite tedavisinden hemen sonra yaşları 28 ve 31 olan iki kadın göğüs ağrısı, taşipne ve taşikardi nedeniyle hastaneye/acil-servise başvurdu. Hastaların ultrasonda batında serbest sıvısı yokken akciğer grafisinde sağ tarafta izole hidrotoraks saptandı. Her iki hastanın da torasentez sonrası semptomları hafifledi. Literatürde olgularımıza benzer şekilde, derlememizin dahil etme kriterlerine uygun 24 olgu takdiminde 41 kadın saptandı. Risk faktörleri yönünden literatürdeki hasta verileri değerlendirildiğinde rapor edilen tüm olguların %81’inde ovulasyon tetikleme günü kan östradiol seviyesi <4000 pg/mL iken, tanı anında olguların %44’ünde hematokrit <%45 idi. İzole hidrotoraks, düşük östradiol düzeyleri ve hematokrit konsantrasyonları olan kadınları bile komplike edebilecek ön görülemez bir olaydır. Klinisyenler, solunum semptomları varlığında belirgin abdominal asit olmasa bile izole hidrotoraks olasılığını akıllarına getirmelidir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık

1. B. Lunenfeld, [Ovarian stimulation: a new approach based on recent physiological and clinical data. Future perspectives], Contracept Fertil Sex 1993;4:1-7.
2. Golan A, Ron-el R, Herman A, Soffer Y, Weinraub Z, Caspi E. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv 1989;44:430-40.
3. Whelan JG 3rd, Vlahos NF. The ovarian hyperstimulation syndrome. Fertil Steril. 2000;73:883-96.
4. M. Practice Committe of the American Society for Reproductive. Ovarian hyperstimulation syndrome. Fertil Steril 2003;801309-14.
5. Abramov Y, Elchalal U, Schenker JG. Pulmonary manifestations of severe ovarian hyperstimulation syndrome: a multicenter study. Fertil Steril 1999;71:645-51.
6. Beji O, Brahmi N, Thabet H, Mokline A, Abidi N, Blel Y, et al. Compressive pleural effusion after ovarian hyperstimulation syndrome--a case report and review. Fertil Steril 2008;89:1826.
7. 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.
8. Ciepiela P, Brelik P, Baczkowski T, Kurzawa R. Isolated severe hydrothorax with respiratory distress as a main manifestation of ovarian hyperstimulation syndrome preceded by respiratory tract infection caused by Haemophilus influenzae. Ginekol Pol 2007;78:570-3.
9. Qublan HS, Barakat M. Respiratory distress caused by a unilateral hydrothorax as only manifestation of ovarian hyperstimulation syndrome. J Obstet Gynaecol 2006;26:585-6.
10. Murray A, Rombauts L. Unilateral pleural effusion as the main presentation of “early onset” severe ovarian hyperstimulation syndrome. Fertil Steril 2004;81:1127-9.
11. Thomas F, Kalfon P, Niculescu M. Acute respiratory failure, lactic acidosis, and shock associated with a compressive isolated right pleural effusion following ovarian hyperstimulation syndrome. Am J Med 2003;114:165-6.
12. Aldawood AS, Felemban AA. Isolated unilateral pleural effusion as the only manifestation of the ovarian hyperstimulation syndrome. Saudi Med J 2003;24:1397-9.
13. Tansutthiwong AA, Srisombut C, Rojanasakul A. Unilateral massive pleural effusion as the only principal manifestation of severe ovarian hyperstimulation syndrome. J Assist Reprod Genet 2000;17:454-6.
14. Roden S, Juvin K, Homasson JP, Israel-Biet D. An uncommon etiology of isolated pleural effusion. The ovarian hyperstimulation syndrome. Chest 2000;118:256-8.
15. Jacob S, Byrne P, Harrison RF. Symptomatic cystic swelling at the root of the neck with left sided pleural effusion as a presentation of ovarian hyperstimulation syndrome. Br J Obstet Gynaecol 1999;106:986-8.
16. Wood N, Edozien L, Lieberman B. Symptomatic unilateral pleural effusion as a presentation of ovarian hyperstimulation syndrome. Hum Reprod 1998;13:571-2.
17. Friedler S, Rachstein A, Bukovsky I, Ron-El R, Raziel R. Unilateral hydrothorax as a sole and recurrent manifestation of ovarian hyperstimulation syndrome following in-vitro fertilization. Hum Reprod 1998;13:859-61.
18. Man A, Schwarz Y, Greif J. Pleural effusion as a presenting symptom of ovarian hyperstimulation syndrome. Eur Respir J 1997;10:2425- 6.
19. Arikan G, Giuliani A, Gucer F, Auner H, Urdl W. Rare manifestations of the ovarian hyperstimulation syndrome: a report of two cases. Clin Exp Obstet Gynecol 1997;24:154-6.
20. Levin MF, Kaplan BR, Hutton LC. Thoracic manifestations of ovarian hyperstimulation syndrome. Can Assoc Radiol J 1995;46:23-6.
21. 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.
22. Rabinerson D, Shalev J, Royburt M, Ben-Rafael Z, Dekel A. Severe unilateral hydrothorax as the only manifestation of the ovarian hyperstimulation syndrome. Gynecol Obstet Invest 2000;49:140-2.
23. Hsieh MJ, Tsao TC, Cheng PJ. Ovarian hyperstimulation syndrome with minimal ascites and massive pleural effusion: report of a case. J Formos Med Assoc 1994;93:882-4.
24. Yildizhan R, Adali E, Kolusari A, Kurdoglu M, Ozgokce C, Adali F. Ovarian Hyperstimulation Syndrome with pleural effusion: a case report. Cases J 2008;1:323.
25. 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.
26. George K, Aleyamma T, Kamath M, Chandy A, Mangalaraj AM, Muthukumar K, Londhe V. Symptomatic unilateral pleural effusion: A rare presentation of ovarian hyperstimulation syndrome. J Hum Reprod Sci 2010;3:49-51.
27. Mullin CM, Fino ME, Reh A, Grifo JA, Licciardi F. Symptomatic isolated pleural effusion as an atypical presentation of ovarian hyperstimulation syndrome. Case Rep Obstet Gynecol 2011;2011:967849.
28. Junqueira JJ, Bammann RH, Terra RM, Castro AC, Ishy A, Fernandez A. “Pleural effusion following ovarian hyperstimulation. J Bras Pneumol 2012;38:400-3.
29. Bass LC, Dillard TA, Forseen CJ, Davis WB. An unusual cause of massive pleural effusion. Am J Med Sci 2012;344:505-7.
30. Murat MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ evidence-based medicine 2018;23:60-63.
31. Kirschner PA. Porous diaphragm syndromes. Chest Surg Clin N Am 1998;8:449-72.
32. Huang PM, Chang YL, Yang CY, Lee YC. The morphology of diaphragmatic defects in hepatic hydrothorax: thoracoscopic finding. J Thorac Cardiovasc Surg 2005;130:141-5.
33. Practice Committee of the American Society for Reproductive Medicine. Electronic address and M. Practice Committee of the American Society for Reproductive. Prevention

APA	Mumusoglu S, Tanacan A, Turan V, Bozdag G (2020). Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature. , 65 - 72. 10.4274/tjod.galenos.2019.89656
Chicago	Mumusoglu Sezcan,Tanacan Atakan,Turan Volkan,Bozdag Gurkan Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature. (2020): 65 - 72. 10.4274/tjod.galenos.2019.89656
MLA	Mumusoglu Sezcan,Tanacan Atakan,Turan Volkan,Bozdag Gurkan Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature. , 2020, ss.65 - 72. 10.4274/tjod.galenos.2019.89656
AMA	Mumusoglu S,Tanacan A,Turan V,Bozdag G Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature. . 2020; 65 - 72. 10.4274/tjod.galenos.2019.89656
Vancouver	Mumusoglu S,Tanacan A,Turan V,Bozdag G Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature. . 2020; 65 - 72. 10.4274/tjod.galenos.2019.89656
IEEE	Mumusoglu S,Tanacan A,Turan V,Bozdag G "Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature." , ss.65 - 72, 2020. 10.4274/tjod.galenos.2019.89656
ISNAD	Mumusoglu, Sezcan vd. "Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature". (2020), 65-72. https://doi.org/10.4274/tjod.galenos.2019.89656

APA	Mumusoglu S, Tanacan A, Turan V, Bozdag G (2020). Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature. Turkish Journal of Obstetrics and Gynecology, 17(1), 65 - 72. 10.4274/tjod.galenos.2019.89656
Chicago	Mumusoglu Sezcan,Tanacan Atakan,Turan Volkan,Bozdag Gurkan Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature. Turkish Journal of Obstetrics and Gynecology 17, no.1 (2020): 65 - 72. 10.4274/tjod.galenos.2019.89656
MLA	Mumusoglu Sezcan,Tanacan Atakan,Turan Volkan,Bozdag Gurkan Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature. Turkish Journal of Obstetrics and Gynecology, vol.17, no.1, 2020, ss.65 - 72. 10.4274/tjod.galenos.2019.89656
AMA	Mumusoglu S,Tanacan A,Turan V,Bozdag G Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature. Turkish Journal of Obstetrics and Gynecology. 2020; 17(1): 65 - 72. 10.4274/tjod.galenos.2019.89656
Vancouver	Mumusoglu S,Tanacan A,Turan V,Bozdag G Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature. Turkish Journal of Obstetrics and Gynecology. 2020; 17(1): 65 - 72. 10.4274/tjod.galenos.2019.89656
IEEE	Mumusoglu S,Tanacan A,Turan V,Bozdag G "Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature." Turkish Journal of Obstetrics and Gynecology, 17, ss.65 - 72, 2020. 10.4274/tjod.galenos.2019.89656
ISNAD	Mumusoglu, Sezcan vd. "Ovarian hyperstimulation syndrome presenting with isolated unilateral right-side hydrothorax: A report of two cases and systematic review of the literature". Turkish Journal of Obstetrics and Gynecology 17/1 (2020), 65-72. https://doi.org/10.4274/tjod.galenos.2019.89656