case_images: PMC10465253_01
case_images: HRCT thorax right pleural effusion and raised right hemidiaphragm. HRCT: high-resolution computed tomography.
case_images: CRIS2023-5493232.001.jpg
case_images: PMC10465253_01_CRIS2023-5493232.001.jpg
case_images: fig1
case_images: High-resolution CT thorax showed right pleural effusion and a raised right hemidiaphragm, suggesting phrenic nerve palsy (Figure 1).
case_images: (a) RATS exploration showing haemorrhagic effusion; (b) endometrial chocolate lesion over the pleural surface (circled) and healed lesion (arrow); (c) adhesions (arrow) between the right lung and the diaphragm; (d) diaphragmatic fenestrations (arrow). RATS: robotic-assisted thoracic surgery.
case_images: CRIS2023-5493232.002.jpg
case_images: PMC10465253_01_CRIS2023-5493232.002.jpg
case_images: fig2
case_images: She underwent 3 port RATS exploration using the DaVinci Xi  robotic surgical system, which revealed a haemorrhagic effusion (Figure 2(a)) and chocolate endometrial lesions on the parietal and diaphragmatic surfaces (Figure 2(b)). There were multiple adhesions between the right lung and the diaphragm and between the diaphragm and the chest wall with diaphragmatic fenestrations (Figures 2(c) and 2(d)).
case_images: (a) Endometrial lesion biopsy; (b) adhesiolysis; and (c) diaphragm plication.
case_images: CRIS2023-5493232.003.jpg
case_images: PMC10465253_01_CRIS2023-5493232.003.jpg
case_images: fig3
case_images: A litre of haemorrhagic fluid was drained, and several of the pleural lesions were biopsied and sent for histology (Figure 3(a)). Adhesiolysis mobilised the lung from the diaphragm (Figure 3(b)), and the diaphragm was plicated using a barbed non-absorbable one suture. (Figure 3(c)).