Thoracic Endometriosis Research Articles

Клинико-патогенетические аспекты торакального эндометриоза

Thoracic endometriosis is a rare pathology that significantly affects the quality of life of women. The pathogenesis of endometriosis continues to be intensively studied. One of the latest achievements in its study is the identification of oxidative stress as an active link in the development of a pathological condition. The nitric oxide molecule is a free radical and, as a result, an important component of oxidative processes. Violation of its metabolism makes a significant contribution to the occurrence of oxidative stress. The NOS3 endothelial synthase gene controls nitric oxide metabolism. We have studied the polymorphism of the NOS3 endothelial synthase gene at points 786 T/C and 894 G/T. The data obtained indicate the active participation of the NOS3 endothelial synthase gene at points 786 T/C and 894 G/T in the pathogenesis of various forms of endometriosis. The difficulties of diagnosing and treating this disease at the present stage are not least due to the fact that the problem of thoracic endometriosis is at the junction of the specialties of obstetrics-gynecology and thoracic surgery, which in other situations practically do not intersect. Our observations make it possible to consider thoracic endometriosis as a pathological process that is not associated with fertility and parity of patients. At the same time, thoracic endometriosis is most likely associated with genital endometriosis, which has a negative impact on fertility. The most common complaints of patients with thoracic endometriosis are pain and discomfort in the chest area associated with menstruation and dry cough. Histological verification of the disease is difficult. A promising method for preventing exacerbations of the disease is the combined prescription of аGnRG and dienogest.

Thoracic Endometriosis Syndrome (TES) in Martinique, a French West Indies Island.

Endometriosis is a female disease that affects 5-10% of women of childbearing age, with predominantly pelvic manifestations. It is currently declared as a public health priority in France. Thoracic endometriosis syndrome (TES) is the most common extra-pelvic manifestation. The objective of this study was to describe the epidemiological and clinical characteristics, and outcomes of patients with TES in Martinique. We performed a descriptive, retrospective study including all patients managed at the University Hospital of Martinique for TES between 1 January 2004 and 31 December 2020. During the study period, we identified 479 cases of pneumothorax, of which 212 were women (44%). Sixty-three patients (30% of all female pneumothorax) were catamenial pneumothorax (CP) including 49 pneumothoraxes alone (78% of catamenial pneumothorax) and 14 hemopneumothorax (22% of catamenial pneumothorax). There were 71 cases of TES, including 49 pneumothoraxes (69%), 14 hemopneumothoraxes (20%) and 8 hemothorax (11%). The annual incidence of TES was 1.1 cases/100,000 inhabitants. The prevalence of TES was 1.2/1000 women aged from 15 to 45 years and the annual incidence of TES for this group was 6.9/100,000. The annual incidence of CP was 1 case/100,000 inhabitants. The average age at diagnosis was 36 ± 6 years. Eight patients (11%) had no prior diagnosis of pelvic endometriosis (PE). The mean age at pelvic endometriosis diagnosis was 29 ± 6 years. The mean time from symptom onset to diagnosis was 24 ± 50 weeks, and 53 ± 123 days from diagnosis to surgery. Thirty-two patients (47%) had prior abdominopelvic surgery. Seventeen patients (24%) presented other extra-pelvic localizations. When it came to management, 69/71 patients (97%) underwent surgery. Diaphragmatic nodules or perforations were found in 68/69 patients (98.5%). Histological confirmation was obtained in 55/65 patients who underwent resection (84.6%). Forty-four patients (62%) experienced recurrence. The mean time from the initial treatment to recurrence was 20 ± 33 months. The recurrence rate was 16/19 (84.2%) in patients who received medical therapy only, 11/17 (64.7%) in patients treated by surgery alone, and 17/31 (51.8%) in patients treated with surgery and medical therapy (p = 0.03). We observed a very high incidence of TES in Martinique. The factors associated with this high incidence in this specific geographical area remain to be elucidated. The frequency of recurrence was lower in patients who received both hormone therapy and surgery.

Diagnosis and management of thoracic endometriosis syndrome: Case report

Introduction: While the diagnosis of endometriosis is relatively common, thoracic endometriosis is a rare manifestation. Thoracic Endometriosis Syndrome (TES) most commonly presents with pneumothorax, 3% which are bilateral, making this case unique in the already limited breadth of TES with catamenial hemopneumothorax. Additionally, this patient had laboratory values constant with ovarian suppression yet continued menses and recurrent hemopneumothorax, necessitating surgical intervention. We propose that with this severity of disease a combination of surgical intervention and hormonal therapy is the ideal approach, providing the lowest rate of recurrence. Case description: A 33 year old woman with 2-day history of chest pain and shortness of breath with heavy menstrual cycles and significant dysmenorrhea. A chest radiograph and computed tomography scan revealed right-sided pneumothorax and bilateral hemothoraces with left-sided diaphragmatic hernia. Video-assisted thoracoscopic surgery confirmed sanguinous pleural effusions and biopsy proven endometriotic lesions. The patient was started on a gonadotropin-releasing hormone agonist and experienced short-interval recurrence of her symptoms. An aromatase inhibitor was added to her regimen and she underwent a left diaphragmatic hernia repair. Conclusions: The recurrence of symptoms despite complete hypothalamic-pituitary-ovarian axis suppression, in addition to the surgical requirements and findings make this case unique in the already limited breadth of thoracic endometriosis syndrome with catamenial hemopneumothorax.

The Combined Robotic-assisted Laparoscopic and Thoracic Approach in the Management of Diaphragmatic, Pleural, and Pericardial Endometriosis

To demonstrate the advantages of a combined robotic-assisted laparoscopic and thoracic approach in the management of extensive diaphragmatic, pleural, and pericardial endometriosis. A video article demonstrating excision of endometriosis from pericardium, diaphragm, and pleura. Thoracic endometriosis is the most common site of extrapelvic endometriosis [1]. Surgical treatment aims to excise all visible disease to relief symptoms and prevent recurrence [2-4]. A 41-year-old lady with cyclical shoulder tip and chest pain and known extensive diaphragmatic endometriosis was referred to our center. The procedure was done jointly by a gynecologist and a thoracic surgeon experienced in robotic-assisted endometriosis excision (Supplemental Video 1). Robotic-assisted laparoscopy revealed extensive full-thickness diaphragmatic endometriosis and a full-thickness pericardial nodule. Pericardial endometriosis excision was performed and a 1 cm defect was left open in the pericardium. Multiple diaphragmatic endometriotic nodules were excised and pleural cavity was entered (Image 2). On robotic-assisted thoracic surgery, further deep endometriotic lesions were detected and excised from the posterior aspect of the diaphragm. These lesions were not identified abdominally despite complete division of falciform ligament, full mobilization of the liver, and the use of a 30-degree scope. Superficial endometriotic lesions on parietal pleura were also detected (Image 3) and excised. The defects on the diaphragm were closed (Image 4). Chest and abdominal drains were left in situ. The patient was discharged on day 4. The combined robotic-assisted laparoscopic and thoracic approach is indicated in selected cases and allows full exploration of the thoracic cavity and both sides of the diaphragm, thus preventing incomplete excision of the disease. Robotic surgery also allows smooth dual-surgeon teamwork.

Catamenial pneumothorax: Not only VATS diagnosis.

Catamenial pneumothorax (CP) is a rare type of spontaneous, recurring pneumothorax occurring in women, from the day before menstruation until 72 hours after its beginning. Conservative treatment is generally associated with recurrence of CP. Video-assisted thoracic surgery (VATS) approach allows not only to obtain diagnosis but also to guide definitive treatment of causing lesions, such as ectopic endometrial implants or diaphragmatic defects and fenestrations. We report our experience in VATS management of CP to focus on its role in CP. In this retrospective observational study, we collected data from women referred to our center for CP, from January 2019 to April 2022. All patients underwent VATS approach, with muscle-sparing thoracotomy when diaphragmatic fenestrations were detected, to perform selective diaphragmatic plication and/or partial diaphragmatic resection. Results were analyzed in terms of pneumothorax recurrence after surgical treatment. All patients were referred to gynecologists for medical therapy. Eight women (median age 36 years, range: 21-45), all with right side CP, were included; three already had pelvic endometriosis and two had already undergone lung apicectomy at other institutions. VATS allowed us to detect diaphragmatic fenestrations in seven patients (87.5%) and apical bullae in five (62.5%). Apicectomy was performed in five cases (62.5%), selective diaphragmatic plication in two (25%), and partial diaphragmatic resection in five (62.5%). Chemical pleurodesis with talc was performed in all to minimize the risk of recurrence. Pathological diagnosis of endometriosis on the resected diaphragm was achieved in five patients (62.5%). No recurrence occurred, except for one woman who stopped medical treatment for endometriosis. In the management of patients with CP, VATS should be recommended not only to obtain an explorative diagnosis of ectopic endometrial implants or diaphragmatic fenestrations but also to allow the most appropriate surgical treatment and obtain pathological specimens for confirmation and definitive diagnosis of thoracic endometriosis. Medical therapy to achieve ovarian rest is mandatory in the postoperative period and should not be discontinued.

Take a deep breath: a multidisciplinary approach to thoracic endometriosis

Take a deep breath: a multidisciplinary approach to thoracic endometriosis

A COMPLICATED CASE OF THORACIC ENDOMETRIOSIS WITH CATAMENIAL HEMOTHORAX AND CONCOMITANT PULMONARY EMBOLISM

A COMPLICATED CASE OF THORACIC ENDOMETRIOSIS WITH CATAMENIAL HEMOTHORAX AND CONCOMITANT PULMONARY EMBOLISM

RECURRENT CATAMENIAL PNEUMOTHORAX: AND WE THOUGHT OUR CRAMPS WERE BAD

RECURRENT CATAMENIAL PNEUMOTHORAX: AND WE THOUGHT OUR CRAMPS WERE BAD

Thoracic endometriosis: A case of one step multidisciplinary surgical treatment

We describe a case of thoracic endometriosis in a patient with a repeated episode of spontaneous pneumothorax. Investigations revealed diaphragmatic fenestrations and right-sided pleural and lung endometriosis. Considering the ultrasound evidence of pelvic endometriosis, the patient was scheduled for multidisciplinary surgical management, to treat in one step thoracic and pelvic endometriosis.

A Fortunate Twist

Question: A 37-year-old Chinese woman was presented with a 1-day history of colicky central abdominal pain associated with 5 episodes of vomiting and diarrhea. It was the third day of her menstrual cycle. On examination, the abdomen had generalized distension without tenderness. There were no significant constitutional symptoms or family history of bowel malignancy, or personal history of inflammatory bowel disease. Her past medical and surgical history reveals a previous large left endometriotic cyst of 14 cm in 2010 for which she underwent a laparoscopic cystectomy, as well as primary subfertility for which she was undergoing her third cycle of in vitro fertilization (IVF) at the time of presentation. Initial blood investigations revealed elevated white cell count of 17,500/mm3, a normal hemoglobin of 15.4 g/dL, and borderline raised C-reactive protein of 36.2 mg/dL. Computed tomography scan of the abdomen and pelvis revealed small bowel obstruction with transition points at the terminal/distal ileum where enhancing intramural lesions has resulted in luminal narrowing and bulging at the ileocaecal junction (Figure A). There were also several small lesions indeterminate for peritoneal nodules. The patient was offered diagnostic laparoscopy with potential for laparotomy and bowel resection to relieve the obstruction. What do you think the final diagnosis was? See the Gastroenterology website (www.gastrojournal.org) for more information on submitting to Gastro Curbside Consult. During diagnostic laparoscopy, hemorrhagic ascites was noted, which was sent for cytology. A decision was made to convert to a laparotomy in view of limited workspace due to the grossly dilated bowel loops. Intraoperative findings were significant for 2 lesions – 1 in the terminal ileum and the other in the ileocaecal valve (Figures B and C), causing small bowel obstruction. Three peritoneal nodules were noted, biopsied, and sent for histology (Figure D). A limited right hemicolectomy was performed to remove the lesions causing obstruction. The patient made a full recovery 6 days after surgery and was discharged well. Histology reports for both the peritoneal nodules and the right hemicolectomy specimen were consistent with endometriosis. Endometriosis is a common gynecologic condition where endometrium, which usually lines the uterine cavity, is found in other areas of the body. When endometrial tissue starts to grow in the ovaries or fallopian tubes, this may result in blockages in the fallopian tubes, which may form scar tissue and reduce the fertility of a woman. Such patients can be offered IVF. However, there is a potential risk of worsening endometriosis due to ovarian hyperstimulation syndrome.1Seyer-Hansen M. Egekvist A. Forman A. et al.Risk of bowel obstruction during IVF treatment of patients with deep infiltrating endometriosis.Acta Obstet Gynecol Scand. 2018; 97: 47-52Crossref PubMed Scopus (17) Google Scholar Although uncommon, gastrointestinal tract involvement by endometriosis can occur with 90% of lesions localized to the terminal ileum, sigmoid colon, or rectum. However, acute bowel obstruction as a complication of bowel endometriosis is rare and only accounts for <1% of most presentations.2De Ceglie A. Bilardi C. Blanchi S. et al.Acute small bowel obstruction caused by endometriosis: a case report and review of the literature.World J Gastroenterol. 2008; 14: 3430-3434Crossref PubMed Scopus (79) Google Scholar In this case vignette, the initial top differential was that of a neoplastic lesion with peritoneal metastases. In retrospect, endometriosis involving the gastrointestinal tract should have been considered as a differential diagnosis. The patient had a known history of endometriosis with history of colicky abdominal pain during menstruation that could well be related to intermittent subacute bowel obstruction caused by bowel endometriosis. The patient was also undergoing IVF, which could lead to ovarian hyperstimulation syndrome and increase symptoms related to endometriosis. Other rare manifestations of symptomatic endometriosis during IVF treatment include that of thoracic endometriosis as well as urogenital endometriosis, which can cause ureteral obstruction.3Ponticelli C. Graziani G. Montanari E. Ureteral endometriosis: a rare and underdiagnosed cause of kidney dysfunction.Nephron Clin Practice. 2010; 114: c89-c94Crossref PubMed Scopus (0) Google Scholar

Thoracic and diaphragmatic endometriosis: an overview of diagnosis and surgical treatment.

Thoracic endometriosis is a rare disease that can lead to a variety of clinical manifestations. There are currently no guidelines for optimal diagnosis and management of the disease. The purpose of this review is to provide an overview of the diagnosis and surgical treatment of thoracic endometriosis. Various imaging modalities, including computed tomography (CT), MRI and ultrasound, have been reported in the detection of thoracic endometriosis. MRI is the most sensitive imaging study and may aid in preoperative planning. Histopathology of a biopsied lesion remains the gold standard for diagnosis. Surgical management of thoracic endometriosis may involve laparoscopy and/or thoracoscopy, and surgical planning should include preparation for single ventilation capability. A multidisciplinary approach involving a gynaecologic surgeon and thoracic surgeon may be considered. Repairing diaphragm defects and pleurodesis are shown to decrease recurrent symptoms. Although optimal diagnostic testing remains uncertain, a high clinical suspicion for thoracic endometriosis is critical to ensure prompt diagnosis and treatment in order to prevent recurrent symptoms and progression to more serious sequalae. Minimally invasive surgical techniques are becoming increasingly utilized and allow for thorough evaluation and treatment of thoracic endometriosis.

Shortness of breath in a young lady, rare case report of thoracic endometriosis.

Introduction and importanceEndometrial glandular tissue can implant in the thorax of women suffering from endometriosis. The clinical presentation is depends on site of implantation. Complications include pneumothorax, pneumohemothorax or hemothorax.Case presentationA 31 year old woman with history of infertility presented with shortness of breath and was found to have a significant right sided pneumohemothorax. Drainage was done followed by chemical pleurodesis using bleomycin with resolution of symptoms on her follow up.Clinical discussionThoracic endometriosis tend to present with chronic or sub-acute symptoms which are non-specific symptoms leading to late diagnosis. Video Assisted Thoracoscopic surgery offer both diagnostic and therapeutic in thoracic endometriosis. However in limited settings chemical pleurodesis can be carried out done to prevent recurrence of shortness of breath due to thoracic endometriosis.ConclusionTherefore, clinical suspicion of thoracic endometriosis in evaluation of shortness of breath in a young lady with history of infertility or pelvic surgery is indispensable.

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.

Catamenial Pneumothorax as the First Expression of Thoracic Endometriosis Syndrome and Pelvic Endometriosis

Objective: The menstrual-related catamenial pneumothorax (CP) can be the first expression of thoracic endometriosis syndrome (TES), which is the presence of endometriotic lesions in the lungs and pleura, and pelvic endometriosis (PE). This study aims to analyze our experience with this specific correlation describing our multidisciplinary approach to CP. Methods: Hospital records of 32 women, operated for CP at our Department from January 2001 to December 2021 were reviewed. Surgical treatment consisted of videothoracoscopy and laparoscopy when indicated. Results: TES and PE were diagnosed in 13 (40.6%) and 12 (37.5%) women, respectively. The association of TES and PE was present in 11 cases (34%). Fifteen patients (46.9%) underwent laparoscopy, of which 11 concurrently with videothoracoscopy. Most of the patients affected had stage III–IV endometriosis (40.6%). All patients received hormonal therapy after surgery. Five patients with PE conceived spontaneously resulting in six live births. The mean follow-up was 117 ± 71 months (range 8–244). Pneumothorax recurrence occurred in six patients (18.8%). At present, all women are asymptomatic, with no sign of pneumothorax recurrence. Conclusions: CP might be the first expression of TES and/or PE. A multidisciplinary approach is advocated for optimal management of the disease.

Catamenial pneumothorax – are there benefits of cooperation between the surgeon and the gynaecologist?

Catamenial pneumothorax (CP) is an uncommon disease related to thoracic endometriosis or diaphragmatic perforation. It is defined as an occurrence of spontaneous pneumothorax around the time of menstruation in the population of women of reproductive age with no other lung diseases. Catamenial pneumothorax is often misdiagnosed and classified as a spontaneous pneumothorax, and no in-depth gynaecological diagnostic is performed. Here we present 3 cases of female patients admitted to the Department of Thoracic Surgery with the aim of surgical treatment of recurrent CP. In all 3 cases, a temporal association between pneumothorax and menstruation was identified. In 2 presented cases the patients were diagnosed with endometriosis and other gynaecological diseases. The previous incidents of CP were treated conservatively, with suction drainage of the pleural cavity or with thoracocentesis, but the treatment did not prevent relapses. In the Department of Thoracic Surgery, each patient was operated on with the use of video-assisted thoracoscopic surgery, which is considered to be a good therapeutic option. In the case of 2 patients the surgery eliminated the relapses, 1 patient required radical lung decortication. The literature on the subject indicates the potential benefits of hormonal treatment of CP. It is suggested that using such pharmacological treatment may reduce the risk of relapse after surgery.

"Pneumothorax Associated with Thoracic Endometriosis: Current Knowledge"

"Pneumothorax Associated with Thoracic Endometriosis: Current Knowledge"

P1‐19: Thoracic endometriosis diagnosed with the aid of the pleuroscopy

P1‐19: Thoracic endometriosis diagnosed with the aid of the pleuroscopy

CATAMENIAL CONUNDRUM: A CASE OF PULMONARY EMBOLISM IN A PATIENT WITH CATAMENIAL PNEUMOTHORAX

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Endometriosis is a common condition affecting about 10% of reproductive-age women, in which ectopic endometrial tissue is found outside of the uterine cavity [1]. While it most commonly affects the pelvis, rarely endometrial tissue can also be found in the chest, often presenting as catamenial pneumothorax [2]. There have also recently been reports of systemic effects of endometriosis such as supporting a pro-inflammatory and prothrombotic state, increasing the risk for deep vein thrombosis (DVT) and pulmonary embolism (PE) [3]. CASE PRESENTATION: A 32 year old woman with endometriosis presented to the hospital with several weeks of pleuritic chest pain, nausea, vomiting, and inability to tolerate oral intake. Several months prior, she was diagnosed with thoracic endometriosis after a hospitalization for chest pain and discovery of bilateral pneumothoraces and pleural effusions, necessitating bilateral chest tube placement. Her consequent outpatient course was complicated by an unprovoked DVT, for which she was started on apixaban. She was admitted to the hospital the next month for worsening dyspnea and underwent computed tomography angiography of the chest and was found to have a left lower lobe subsegmental pulmonary embolism and loculated bilateral pneumothoraces, leading to video-assisted thoracoscopic surgery with decortication, pleural biopsy, and chemical pleurodesis for catamenial pneumothorax, with improvement in symptoms (Image 1). Anticoagulation (AC) was switched from oral apixaban to enoxaparin injections 1.5mg/kg daily, with a plan for clinic follow up for further AC management. DISCUSSION: Extrathoracic involvement is a rare and challenging presentation of endometriosis, often necessitating invasive interventions, and associated with recurrence rates of up to 14% (4). Our patient presented the challenge of requiring AC for her PE while managing bleeding risk in the setting of endometriosis, all while being unable to tolerate oral medications due to nausea and vomiting associated with endometriosis. In such patients, injectable, quickly reversible options for AC such as enoxaparin should be considered. CONCLUSIONS: There have been several studies suggesting that endometriosis supports a prothrombotic state, making it imperative to remember this dual challenge when treating endometriosis patients, and to have a low threshold for suspecting PE in any patient with persistent chest discomfort even after treatment of catamenial pneumothorax. Management should be individualized, with attention to the effect of related systemic complications such as nausea and vomiting precluding oral medication success to prevent potentially devastating consequences. REFERENCE #1: Shafrir AL, Farland LV, Shah DK, et al. Risk for and consequences of endometriosis: A critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol. 2018;51:1-15. REFERENCE #2: Mecha E, Makunja R, Maoga JB, et al. The Importance of Stromal Endometriosis in Thoracic Endometriosis. Cells. 2021;10(1):180. Published 2021 Jan 18. REFERENCE #3: Ding D, Liu X, Guo SW. Further Evidence for Hypercoagulability in Women With Ovarian Endometriomas. Reprod Sci. 2018;25(11):1540-1548. DISCLOSURES: No relevant relationships by Teressa Ju, source=Web Response No relevant relationships by Gina Villani, source=Web Response No relevant relationships by Angelina Voronina, source=Web Response

CATAMENIAL PNEUMOTHORAX: PRESENTATION OF A CASE AND REVIEW OF THE LITERATURE

Endometriosis is dened as the presence of functional extra-uterine endometrial tissue, which can suffer hemorrhage, inammation, brosis and adhesion formation, causing pelvic pain and infertility. The chest is a place where the presentation of endometriosis is rare, its diagnosis is based on the clinical picture of pneumothorax without associated trauma but with cyclical presentation. The pathological study is based on the presence of stroma and endometrial glands. The management of thoracic endometriosis is medical based on hormonal treatment, and surgical management for the management of complications or resection of the ovaries and hysterectomy to avoid recurrence. We present a case of a patient with recurrent catamenial pneumothorax.

A Case Report of Recurrent Spontaneous Pneumothorax Secondary to Thoracic Endometriosis Syndrome

Endometriosis is a benign condition in which ectopic endometrial glands and stroma are present outside of the uterine cavity. It commonly affects the pelvic organs but can also spread throughout the entirety of the body, including the thoracic cavity. The ectopic presence of endometrial glands and stroma in lung or pleura can produce a range of clinical and radiological manifestations – catamenial pneumothorax, catemenial hemothorax, catamenial hemoptysis, and pulmonary nodules – collectively referred to as “thoracic endometrial syndrome.” Thoracic endometriosis constitutes an uncommon cause of spontaneous pneumothorax in nonsmoking women of childbearing age. Symptoms are often non-specific and the diagnosis is often delayed. A thorough menstrual history and its temporal relationship to pneumothorax onset should be assessed in every women presenting with recurrent pneumothorax. Thoracic endometriosis syndrome is very manageable with the advancements of VATS and hormonal therapy, but we as clinicians should have this on our differential diagnosis when a young, reproductive-aged female presents with a spontaneous pneumothorax to expedite appropriate care. Here we present a case of a 44 year old female with recurrent spontaneous pneumothorax that was attributed to thoracic endometriosis that will hopefully educate providers to have a high clinical suspicion in patients to obtain an accurate diagnosis and initiate proper treatment.