Introduction: Thoracic Endometriosis Syndrome is a rare and complicated case consisting of four distinct entities; Catamenial pneumothorax, catamenial hemothorax, hemoptysis, and lung nodule. This case was made more complicated with presence of deep vein thrombosis to protein C deficiency.
Case Presentation: We report a case of 36 year old female with history DVT who presented with difficulty of breathing and back pain before menstruation. Right sided massive pleural effusion and pulmonary embolism was noted on chest x-ray and on computed tomographic scan. Exudative pleural fluid with hemorrhagic appearance on thoracentesis. Patient also develop catamenial pneumothorax. Chemical pleurodiesis was applied. Patient underwent subtotal hysterectomy with bilateral oophorectomy symptoms resolved after the said procedure. Patient was maintained on warfarin.
Conclusion: Clinician should have high clinical suspicion a female patient, in reproductive age, who complains of sudden chest pain or hemoptysis at the time of menstrual cycle should give the patient a clue for thoracic endometriosis.