A case of a Burkinabe woman who was 41 years old admitted to ER with right sided chest pain on & off, and shortness of breath with increasing intensity is described here. she revealed that she had been experiencing similar episodes of recurrent ride sided chest pain during menstruation for a few months. She had no menstrual problems. but decreased breath sounds on the right side, lower zone. Impaired percussion on the right lower lobe and hyper-resonance in the right axilla. On evaluation her Chest X-ray showed pleural effusion. When the CT was done it was evident of a pleural honeycombing, right sided moderate hydropneumothorax with mild contralateral mediastinal shift. Pleural biopsy showed that HPE revealed content of hemorrhage and fibrin deposits. Infiltration by mononuclear inflammatory cells, occasional neutrophils and hemosiderin laden macrophages with endometrial epithelium.The immunohistochemical study showed CD10, P63, CA125- positive concluded Pleural endometriosis.