Symptomatic Isolated Pleural Effusion as an Atypical Present
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A 25-year-old G0 woman with no significant past medical history or physical findings other than polycystic ovaries on ultrasound enrolled in our Ooctye Donor Program. Downregulation was achieved using OCPs and depot leuprolide acetate 3.75 intramuscularly on day 21. Ovarian stimulation was initiated with 225?IU of human menopausal gonadotropin (hMG) for 5 days. This dose was tapered as a result of the patient's ovarian response, measured by ultrasound and estradiol levels. She received a total of 1975?IU of hMG over 9 days and 500??g of r-hCG when two follicles reached a 17?mm diameter; her peak estradiol level was 3,731?pmol/L. A total of 44 oocytes were retrieved.

The patient initially presented 2 days after oocyte retrieval with complaints of dyspnea on exertion and a 2-pound weight gain. She denied nausea, vomiting, or abdominal distention. She was afebrile but tachycardic. Her lungs were clear on auscultation, abdomen was slightly distended with mild tenderness in the left lower quadrant. Ultrasound evaluation demonstrated no evidence of intraperitoneal fluid, and ovaries were enlarged bilaterally (left: 56 × 89?mm; right: 48 × 81?mm) consistent with moderate hyperstimulation. She had normal electrolytes and renal function, hematocrit was 0.44%; she was initially managed as an outpatient with oral hydration and modified activity. Her symptoms progressed such that by POD #12, she presented with a 5-pound weight gain and nonproductive cough. Her pulse was 118?bpm and saturating 97% on room air. On physical examination, breath sounds were absent in ~66% of the posterior right lung field. Her abdomen remained slightly distended, and on ultrasound, there was still no evidence of intraperitoneal fluid. A chest X-ray (CXR) confirmed a large right pleural effusion....
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