Endometriosis is a common diagnosis in reproductive age women characterized by the presence of endometrial tissue outside the uterine cavity.1 Although it is typically confined to the pelvis, rare manifestations involving the thorax, abdomen or pericardium have been documented.2-5 Even more rare is the concurrent presence of endometriosis- associated hemorrhagic pleural effusion and ascites, which can prove a diagnostic challenge. We describe a case of hemothorax and hemorrhagic ascites in a woman with shortness of breath and abdominal pain.