Endometriosis-related Pneumothorax Research Articles

A surgical series on endometriosis-related diaphragmatic hernia.

Thoracic endometriosis syndrome gives rise to various clinical and radiological manifestations. We reviewed the records of patients operated for intrathoracic migration of abdominal viscera through a diaphragmatic hernia secondary to thoracic endometriosis. We retrospectively reviewed the single-center prospective collected database of all patients operated for thoracic endometriosis during the twenty years. All cases in which an abdominal organ was found to be herniated into the thoracic cavity were retrieved. Clinical and pathological data are presented and analyzed. Twenty women of median age 36 (range 25-58) years were operated for endometriosis-related diaphragmatic hernia. The hernia was diagnosed concomitantly with endometriosis-related pneumothorax in 13 cases and during the exploration of catamenial thoracic pain in seven cases. There were 18 cases on the right side and two cases on the left side. The median diameter of the hernia was 8cm (2.5-20cm). In seventeen cases, the hernia was repaired by direct suture, and in three cases a heterologous prosthesis was positioned. At follow-up, two patients had an episode of recurrent pneumothorax. Diaphragmatic hernia should be ruled out in the presence of endometriosis-related pneumothorax or catamenial thoracic pain. Surgery is indicated to make a pathological diagnosis, restore anatomy, and prevent recurrence in patients presenting with pneumothorax.

In endometriosis-related pneumothorax surgery, presence of endometriotic nodules increases postoperative air leaks and long-term relapse

In endometriosis-related pneumothorax surgery, presence of endometriotic nodules increases postoperative air leaks and long-term relapse

Endometriosis-related pneumothorax

Endometriosis-related pneumothorax

Dynamics of thoracic endometriosis in the pleural cavity.

BackgroundThoracic endometriosis-related pneumothorax is a secondary spontaneous pneumothorax caused by thoracic endometriosis. Diaphragmatic endometriosis is well-studied, but visceral and/or parietal pleural lesions are not. Although surgery is an effective treatment, postoperative recurrence rates are unsatisfactory probably due to inadequate understanding of underlying pathophysiology. We aimed to clarify the clinicopathological features of thoracic endometriosis.MethodsIn total, 160 patients who underwent thoracoscopic surgery from a single institution with histopathologically proven thoracic endometriosis from January 2015 to December 2019 were included. Clinicopathological characteristics and surgical outcomes were assessed retrospectively.ResultsThe cohort median age was 41 (range 22–53) years. Pneumothorax was right-sided in 159 (99.4%) and left-sided in only 1 (0.6%) case. Visceral and parietal pleural lesions were diagnosed in 79 (49.4%) and 71 (44.4%) patients, respectively. In total, 104 visceral pleural lesions and 101 parietal pleural lesions were detected. The S4 region and the dorsal 6th intercostal space contained the largest number of visceral pleural (66 lesions) and parietal pleural lesions (25 lesions), respectively. Histopathological evaluation revealed endometriotic tissues, existing in the outer external elastic layer in all lesions, were localized or invaded deeply. The median follow-up period was 370 (range, 6–1824) days. The Kaplan-Meier method revealed that the 1- and 2-year postoperative recurrence rates were 13.8% and 19.3%, respectively.ConclusionsVisceral pleural endometriotic lesions may be disseminated from the visceral pleural surface and infiltrate into the pleura. Intraoperatively, careful observation of the specific sites, such as the visceral pleura of S4 and the parietal pleura of 6th intercostal space, is important to reduce postoperative recurrence.

Extra-pelvic endometriosis: A review.

BackgroundExtra‐pelvic endometriosis is a rare type of endometriosis, which occurs in a distant site from gynecological organs. The diagnosis of extra‐pelvic endometriosis can be extremely challenging and may result in a delay in diagnosis. The main objective of this review was to characterize abdominal wall endometriosis (AWE) and thoracic endometriosis (TE).MethodsThe authors performed a literature search to provide an overview of AWE and TE, which are the major types of extra‐pelvic endometriosis.Main findingsAbdominal wall endometriosis includes scar endometriosis secondary to the surgical wound and spontaneous AWE, most of which occur in the umbilicus or groin. Surgical treatment appeared to be effective for AWE. Case reports indicated that the diagnosis and treatment of catamenial pneumothorax or endometriosis‐related pneumothorax (CP/ERP) are challenging, and a combination of surgery and postoperative hormonal therapy is essential. Further, catamenial hemoptysis (CH) can be adequately managed by hormonal treatment, unlike CP/ERP.ConclusionEvidence‐based approaches to diagnosis and treatment of extra‐pelvic endometriosis remain immature given the low prevalence and limited quality of research available in the literature. To gain a better understanding of extra‐pelvic endometriosis, it would be advisable to develop a registry involving a multidisciplinary collaboration with gynecologists, general surgeons, and thoracic surgeons.

Thoracic endometriosis syndrome: Comparison between catamenial pneumothorax or endometriosis-related pneumothorax and catamenial hemoptysis

ObjectivesTo evaluate the clinical features of thoracic endometriosis syndrome (TES) represented by catamenial pneumothorax (CP), endometriosis-related pneumothorax (ERP), and catamenial hemoptysis (CH). Study designIn this retrospective study, we enrolled 25 patients with TES, 18 of whom had CP/ERP and 7 had CH, to investigate the clinical presentation, effectiveness of treatment, and recurrence rates in these disorders. ResultsThe age at onset was significantly lower in patients with CH than in patients with CP/ERP (P < 0.05). In 94.4% of patients with CP/ERP, pneumothorax was observed on either the right side or bilaterally, however there was no tendency toward laterality of CH among our cases. In our study, patients with CP/ERP predominantly underwent surgical management and the recurrence rate during treatment was higher in patients with CP/ERP than in those with CH. We found that the recurrence frequency of CP/ERP was lowest under the combination therapy with thoracic surgery and postoperative hormonal therapy. ConclusionOur findings suggest that CP/ERP and CH are different pathological conditions and CP/ERP is more difficult to manage than CH.

Clinical and Pathological Characteristics of Spontaneous Pneumothorax in Women: A 25-Year Single-Institutional Experience

SESSION TITLE: Pleural Disease SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Accumulating evidences suggest that spontaneous pneumothorax (SP) in women is relatively rare but postoperative recurrence is more common compared to men, which may partly be attributed to catamenial/ endometriosis-related pneumothorax. However, detailed clinical-pathological background of female SP is yet to be fully elucidated. Our aim is to further delineate clinical and pathological characteristics of female spontaneous pneumothorax. METHODS: We retrospectively reviewed women with SP undergoing surgery at Kansai Medical University Hospital from January 1990 to December 2015. Female patients with SP with no underlying lung disease were divided into those with age greater than or equal to 50 years (‘Age≥ 50yr’) and those younger than 50 years, latter of which was further subdivided into two categories: patients with catamenial pneumothorax (CP) and those with non-CP. RESULTS: A total of 705 operations were performed for male or female SP during the study period. 71 women underwent 74 operations for their SP. Among these, 12 patients had known underlying lung disease (i.e. secondary SP). 59 patients had SP with no known underlying lung disease: 11 (18.6%) had CP, 40 (67.8%) had non-CP and 8 (13.6%) were Age≥ 50yr. Pathological diagnosis of CP was diaphragmatic endometriosis in 4 cases, emphysematous bullae in 4 cases, pulmonary hemangiomatosis-like foci in 2 cases and hematoma in one case. On the other hand, emphysematous blebs/bullae accounted for all but one case with non-CP and all the SP in Age≥ 50yr, most of which were located in the right or left upper lobe of the lung. The 2-year cumulative ipsilateral recurrence rate of CP, non-CP, and SP in Age≥ 50yr group was 42.0%, 13.8%, and 14.2%, respectively. CP showed significantly higher recurrence rate compared to non-CP (p = 0.006). CONCLUSIONS: This study showed that surgery for female SP accounted for approximately 10% of all surgeries for SP. CP affected approximately 20% of female SP with no underlying lung disease, resulting in a significantly higher postoperative recurrence rate compared to non-CP based on the heterogenous pathology including thoracic endometriosis, emphysematous bullae and pulmonary capillary hemangiomatosis-like foci. CLINICAL IMPLICATIONS: When treating female patients with SP, clinicians may need to consider their age and the presentation of their pneumothoraces (i.e. CP or non-CP). Surgical treatment may not be as effective for CP as for non-CP to prevent the recurrent pneumothorax. DISCLOSURE: The following authors have nothing to disclose: Tomohito Saito, Yukihito Saito, Kento Fukumoto, Hiroshi Matsui, Takahito Nakano, Yohei Taniguchi, Hiroyuki Kaneda, Akiharu Okamura, Yoshiko Uemura, Koji Tsuta, Tomohiro Murakawa No Product/Research Disclosure Information

Experience of treatment of endometriosisrelated pneumothorax

OBJECTIVE. The article analyzed the experience of treatment of endometriosis-related pneumothorax (ERP). MATERIAL AND METHODS. The diagnosis of ERP was detected in 30 women at the period from 2004 to 2015. A control group consisted of 149 women. RESULTS. Statistically significant differences associated with presence of ERP were the elder age, right-side localization and recurrence course of disease. Diaphragmatic fenestrations and endometriotic ectopy and their combinations were specific findings in ERP-group. This group of patients characterized by frequent recurrences and higher rate of complications. The most effective method of treatment of ERP was diaphragm resection with pleurectomy and hormone therapy from 3 to 6 months after surgery. CONCLUSIONS. Endometriosis-related pneumothorax could cause up to 34 % cases of spontaneous pneumothorax in women of reproductive age. Diaphragmatic fenestrations and endometriotic lesions were specific signs of EAP. Direct visual examination of the pleural cavity was inevitable for reliable diagnostics of the disease. Surgical treatment of ERP was determined by higher rates of complication and recurrence. Postoperative hormone therapy could significantly improve the results of surgical treatment of ERP.

Long-term Follow-up of a Patient with Repeated Pneumothorax during Pregnancy and a History of Catamenial Pneumothorax: A Case Report

We report the subsequent course of a previously-reported (Japanese abstract) case of catamenial pneumothorax (CPT) involving seven recurrences of pneumothorax during pregnancy, treated by thoracoscopic surgery and then small thoracotomy segmental resection and pleural covering with polyglycolic acid felt and fibrin glue. The patient took an oral contraceptive (OC) from 6 months postpartum until discontinuation after 2 years to become pregnant. Pregnancy occurred after 1 year and an elective caesarean section was performed in the 37th week of pregnancy. During that period, there was no evidence of recurrence of pneumothorax. Endometriosis-related pneumothorax during pregnancy recurs with high probability following medical management by thoracic drainage. For pneumothorax during pregnancy occurring on the right side followed by early recurrence after medical management by thoracic drainage, endometriosis should be considered to be a possible cause, particularly when there is a past history of endometriosis. In such cases, we recommend early thoracoscopic surgery comprising not only resection of the endometriosis lesions after careful evaluation but also pleurodesis and/or covering with polyglycolic acid felt and fibrin glue. Further studies are needed to clarify and develop appropriate management of pneumothorax in pregnant women with a history of CPT.

Clinical characteristics of catamenial and non-catamenial thoracic endometriosis-related pneumothorax.

A major pathogenic factor for catamenial pneumothorax is thoracic endometriosis. However, thoracic endometriosis-related pneumothorax (TERP) can develop as either catamenial or non-catamenial pneumothorax (CP). Therefore, the aim of this study was to elucidate the clinical differences between catamenial and non-catamenial TERP. The clinical and pathological data in female patients who underwent video-assisted thoracoscopic surgery at the Pneumothorax Research Center during an 8-year period were retrospectively reviewed. This study included 150 female patients with surgico-pathologically confirmed TERP. The subjects were divided into two groups, those having all of the pneumothorax episodes in the catamenial period (CP group) and those who did not (non-CP group). We compared the clinical characteristics and surgico-pathological findings between these two groups. Of the 150 TERP patients, 55 (36.7%) were classified in the CP group, and 95 (63.3%) in the non-CP group. In regard to the locations of endometriosis, all TERP patients had diaphragmatic endometriosis, while pleural implantation was recognized in 34 of the 55 (61.8%) patients in the CP group and 42 of the 95 (44.2%) patients in the non-CP group (P < 0.05). A significant difference in the proportion of patients with pleural endometriosis was observed between catamenial and non-catamenial TERP. The ectopic sites of the endometriosis may be responsible for the timing of the pneumothorax episodes.

Thoracic endometriosis: clinicopathologic updates and issues about 18 cases from a tertiary referring center.

Thoracic endometriosis is defined as the ectopic presence of endometrial glands and stroma in lung or pleura and constitutes an uncommon cause of spontaneous pneumothorax in nonsmoker women in childbearing age. From 2000 to 2014, 18 (7.3%) women of 246 had a histologically proven endometriosis-related pneumothorax. The examination of thoracic samples was performed on formalin-fixed, paraffin-embedded hematoxylin and eosin-stained slides. Immunohistochemistry was carried out on all samples. The pathologic findings included endometriosis foci appearing as a triad of endometrial glands, stroma, and hemosiderin-laden macrophages in 8 patients. In the remaining 10 patients, minute nests of endometrial stroma were recognized at histologic examination and immunohistochemistry. One patient displayed diaphragmatic endometriosis and pulmonary lymphangioleiomyomatosis. Thoracic endometriosis is an uncommon cause of recurrent pneumothorax necessitating histologic confirmation. The histologic diagnosis of endometriosis may be challenging on small pleural or lung biopsies because endometriosis mostly appears as minute nests of endometrial stromal cells. Here, we present our experience on thoracic endometriosis: considering frequent interpretation difficulties of biopsy samples, we propose a multidisciplinary diagnostic algorithm.

Catamenial pneumothorax: A rare cause of recurrent pneumothorax

Introduction: Primary spontaneous pneumoth- orax is a common clinical occurrence. Although primary spontaneous pneumothorax is twice as common in men as in women. the recurrence rate is significantly higher in women. the two primary causes for recurrence in women are catamenial pneumothorax and endometriosis related pneumothorax. In the past, catamenial and/or endometriosis related pneumothorax were greatly underdiagnosed. the incidence has increased in the past decade because it is more easily recognized today. spontaneous pneumothorax is a lung compression that occurs spontaneously due to air in the pleural space in a patient with no underlying lung disease. It can occur in men or women but occurs most often in men. It occurs through many different causes. catamenial pneumothorax is a spontaneous pneumothorax that occurs at the time of menses in a woman that allows air to enter the thoracic space. Non-catamenial endometriosis related pneumothorax is a spontaneous pneumothorax

Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors

Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors

Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors

Catamenial pneumothorax and thoracic endometriosis (TE) are still under diagnosed. The purpose of this study is to increase the diagnostic accuracy for these conditions in patients with spontaneous pneumothorax and to identify their risk factors. We conducted a retrospective study on all consecutive women of reproductive age referred to our Centre for surgical treatment of spontaneous pneumothorax between July 2000 and January 2009. The study population comprised 156 premenopausal women of whom 49 (31.4%) had catamenial and/or TE-related pneumothorax. Over a quarter of these 49 patients had a previous history of recurrent thoracic or scapular catamenial pain. They experienced their first pneumothorax episode at an older age (mean ± SD) (34.0 years ± 6.7) than women with idiopathic pneumothorax (28.7 ± 6.1 years, P < 0.001). Pelvic endometriosis was found in 51% of women with catamenial and/or TE-related pneumothorax. After adjustment for confounding factors by multiple logistic regression analysis, the results show that, infertility [odd ratio (OR) = 4.21, 95% confidence interval (CI) = 1.28-13.88] and a history of pelvic surgery with a uterine procedure and/or uterine scraping (OR = 2.85, 95% CI = 1.12-7.26) were the strongest predictors of catamenial and/or TE-related pneumothorax. Infertility and uterine procedures are significantly associated with catamenial and/or TE-related pneumothorax. Scapular or thoracic pain during menses often precedes the occurrence of pneumothorax and is highly specific for the diagnosis of TE. Our results suggest that in women with pelvic endometriosis, these symptoms should be systematically investigated for an earlier diagnosis of TE.

Endometriosis-related pneumothorax after in vitro fertilization embryo transfer procedure: A case report

FIGURE 1. Endometrial foci on the parietal pleura, coagulated by argon plasma and removed. Catamenial pneumothorax is a unique clinical entity occurring in ovulating women at the onset of menses. It was considered rare, but in a recent report its incidence amounts to 25% of spontaneous pneumothorax surgically treated in women. This justifies an increasing interest on the topic. Despite the fact that catamenial pneumothorax has been known for 5 decades, its cause has not been defined definitively. Thoracic endometriosis is frequently indicated as an implicated factor; however, the pathogenesis and mechanism that lead to thoracic endometriosis and from endometriosis to pneumothorax are still unclear. To our knowledge, we report the first case of a catamenial pneumothorax in a woman who underwent controlled ovarian hyperstimulation for in vitro fertilization embryo transfer (IVF-ET) cycles, and we add some information to clarify its pathogenesis.

Value of cancer antigen 125 for diagnosis of pleural endometriosis in females with recurrent pneumothorax

The thorax is the most frequent extrapelvic location of endometriosis. Thoracic endometriosis is probably responsible for the high rate of recurrent pneumothoraces in females. The goal of the present prospective study was to assess the value of cancer antigen (CA)125 measurement in the detection of endometriosis in order to further enable early and adequate treatment of catamenial pneumothorax. Between January 2004 and March 2006, 31 females (mean age 32 yrs) underwent pneumothorax surgery. The control group comprised 17 males (mean age 27 yrs), who underwent videothoracoscopic pleural abrasion. Serum CA125 was measured around a menstrual period in females and before surgery in males. Videothoracoscopically diagnosed endometriosis occurred in 29% of females. The CA125 concentration was significantly higher in females with endometriosis compared to disease-free females (76.1 versus 16 U x mL(-1)). The mean value in males was similar to that observed in disease-free females. The frequency of thoracic endometriosis-related pneumothorax corresponds to, on average, a third of females presenting with recurrent pneumothorax. Early detection can be achieved with serum cancer antigen 125 measurement and may be helpful in indicating videothoracoscopic surgery.

Catamenial and Noncatamenial, Endometriosis-related or Nonendometriosis-related Pneumothorax Referred for Surgery

Catamenial and endometriosis-related pneumothorax are considered relatively rare entities. Their clinical characteristics and outcome are incompletely known. To evaluate the frequencies, clinical characteristics, and outcomes of catamenial and endometriosis-related pneumothoraces occurring in women with no underlying lung disease referred for surgical treatment. Clinical files of all the women of reproductive age referred to our center during a 6-year period for surgical treatment of spontaneous pneumothorax were retrospectively reviewed. Catamenial pneumothorax (CP) was defined as recurrent pneumothorax occurring between the day before and within 72 hours after the onset of menses. All histologic slides were reviewed to confirm initial diagnoses. A total of 114 women underwent video-assisted thoracic surgery; 28 women (24.6%) had CP (right-sided in all but one), and diaphragmatic abnormalities (perforations and/or nodules) were observed in 22 of them. Diaphragmatic abnormalities were seen in 21 of 86 patients with non-CP. Histologic examination found endometriosis, mainly diaphragmatic, in 18 of 28 CPs and 11 of 86 non-CPs. A 6-month antigonadotropic treatment was prescribed postoperatively to women with either CP or endometriosis-related pneumothorax. Mean follow-up was 32.7 (+/-18.5) months. Recurrence rates in CP, non-CP but endometriosis-related, and non-CP non-endometriosis-related pneumothoraces were 32, 27, and 5.3%, respectively. Our experience shows that (1) CP and/or endometriosis-related pneumothoraces account for an important percentage of spontaneous pneumothoraces referred for surgery, (2) diaphragmatic abnormalities seem to play a fundamental role in their pathogenesis, and (3) management is difficult because of the high recurrence rate.

Life-Threatening Endometriosis-Related Hemopneumothorax

Catamenial pneumothorax is a relatively rare condition, generally of mild to moderate severity. We report the case of a 29-year-old woman who experienced an episode of life threatening right-sided hemopneumothorax in association with menses. She had already been operated on for recurrent pneumothorax. Treatment of the current episode included urgent tube thoracostomy and iterative thoracotomy, together with lung wedge resection, parietal pleurectomy, and partial diaphragmatic excision. Pathologic examination revealed endometrial implants massively involving the diaphragm, the pleura, and the lung parenchyma. The present report shows that endometriosis-related pneumothorax may be extremely severe. The multiple localizations of endometrial implants in this case may provide a support to the different pathogenic theories of endometriosis-related pneumothorax.

Endometriosis-related pneumothorax: clinicopathologic observations from a newly diagnosed case

thymic masses by indium-111-DTPA-D-pentetreotide scintigraphy. J Nucl Med. 1998;39:634-9. 22. Reisiene T, Bell GI. Molecular biology of somatostatin receptors. Endocr Rev. 1995;16:427-42. 23. Patel YC, Srikant CB. Subtype selectivity of peptide analogs for all five cloned human somatostatin receptors (hsstr 1-5). Endocrinolgy. 1994;135:2814-7. 24. Filosso PL, Ruffini E, Oliaro A, Papalia E, Donati G, Rena O. Long-term survival of atypical bronchial carcinoids with liver metastases, treated with octreotide. Eur J Cardiothorac Surg. 2002;21: 913-7.