Thoracic Endometriosis: Current Knowledge (original) (raw)
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Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management
JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2019
Background:Endometriosis is characterized by the presence of endometrial-like glands and stroma outside the uterine cavity and is believed to affect 6%–10% of reproductive-age women. Endometriosis within the lung parenchyma or on the diaphragm and pleural surfaces produces a range of clinical and radiological manifestations. This includes catamenial pneumothorax, hemothorax, hemoptysis, and pulmonary nodules, resulting in an entity known as thoracic endometriosis syndrome (TES).Database:Computerized searches of MEDLINE and PubMed were conducted using the key words “thoracic endometriosis,” “catamenial pneumothorax,” “catamenial hemothorax,” and “catamenial hemoptysis.” References from identified sources were manually searched to allow for a thorough review.Conclusion:TES can produce incapacitating symptoms for some patients. Symptoms of TES are nonspecific, so a high degree of clinical suspicion is warranted. Medical management represents the first-line treatment approach. When this fails or is contraindicated, definitive surgical treatment for cases of suspected TES uses a combined video laparoscopy performed by a gynecologic surgeon and video-assisted thoracoscopic surgery performed by a thoracic surgeon. Postoperative hormonal suppression may further reduce disease recurrence.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2018
To evaluate the clinical features of thoracic endometriosis syndrome (TES) represented by catamenial pneumothorax (CP), endometriosis-related pneumothorax (ERP), and catamenial hemoptysis (CH). Study design: In 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. Results: The 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. Conclusion: Our findings suggest that CP/ERP and CH are different pathological conditions and CP/ERP is more difficult to manage than CH.
Cureus, 2021
Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. It is usually confined to the pelvis, particularly the ovaries, cul-de-sac, broad ligaments, and uterosacral ligaments, but it can also expand outside the pelvis. The thorax is among the common extrapelvic locations. Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of functioning endometrial tissue in the pleura, lung parenchyma, and airways. This report presents a case of a young female patient with advanced endometriosis and premature ovarian failure who was admitted with dyspnea that turned to be due to a rare endometriosis-related complication.
Thoracic endometriosis, a review
Obstetrics & Gynecology International Journal
Background: Thoracic endometriosis is the most frequent extra-pelvic location of endometrial lesions. Because thoracic endometriosis is an unusual and uncommon diagnosis in women, it is crucial that patients with catamenial chest pain and previous history of endometriosis undergo a thorough work-up. Due to the rarity of this disease a high index of clinical suspicion is imperative to make a diagnosis. Consequently, due to the multi-organ involvement of this disease a multidisciplinary team is required for appropriate investigation, diagnosis, and treatment. Presentation of the case: Patient is a 29-year-old Gravida 2, Para 0020 with a known history of pelvic endometriosis, confirmed by histopathology, was referred to our clinic for evaluation of her chronic pelvic pain, endometriosis, catamenial dyspnea, cyclic chest pain, dysmenorrhea, and menorrhagia. The patient underwent robotic single-incision laparoscopic surgery (SILS) resection of endometriosis, ovarian cystectomy, lysis of adhesions, and cystoscopy by the Minimally Invasive Gynecologic Surgery (MIGS) team. Afterwards, the thoracic surgery team performed bilateral video-assisted laparoscopy surgery (VATS) with assistance from the MIGS to help identify suspicious lesions. Intraoperative evaluation revealed thoracic endometriosis confined to the pleura of the lungs and the diaphragm and were resected. Based on the clinical presentation and intraoperative findings the patient was diagnosed with thoracic endometriosis. Conclusion: Thoracic endometriosis is an unusual, but relatively common diagnosis in women with catamenial chest pain, catamenial dyspnea, and previous history of confirmed endometriosis. Due to the impacts on patient quality of life and the potential complications of thoracic endometriosis, we find it imperative to investigate this patient population.
Catamenial Pneumothorax in a Patient with Endometriosis: A Case Report
Cureus
Pelvic pain is a common presentation to the emergency department (ED). For female patients, endometriosis can be difficult to diagnose and can have life-threatening complications if missed. In this case report, we present a case of a patient initially presenting to the ED with a few days of crampy lower abdominal pain. After initial imaging, she was found to have a large pelvic hematoma with concern for active extravasation and a large hemothorax. After further evaluation, she was suspected of having endometriosis leading to thoracic endometriosis and a catamenial pneumothorax. Although endometriosis is not typically an emergent diagnosis, the complications of significant endometrial tissue spread can cause lifethreatening impacts. Clinicians should consider complications of endometriosis in females of menstruating age.
Thoracic endometriosis presenting as hemopneumothorax
Monaldi Archives for Chest Disease
Thoracic endometriosis is very rare. Usually, the thorax is the most frequent affected site outside the pelvis. Common symptoms include chest pain, dyspnea, and hemoptysis. Common manifestations include pneumothorax, hemothorax, and pulmonary or pleural nodules. In addition, symptoms and manifestations can be “catamenial” happening a few days after menstruation onset. This disease can be debilitating, causing a significant impact on the quality of life of young women. We present a case of a young female who was referred to our hospital with recurrent right-sided pleural effusions and pneumothoraces. Pleural fluid drainage was consistent with hemothorax. Transvaginal ultrasound showed mild intraperitoneal fluid in the Cul-de-Sac. Due to concerns for thoracic endometriosis, video-assisted thoracoscopic surgery was performed confirming the diagnosis by pathology. Therapeutic pleurectomy with diaphragmatic repair and pleurodesis was performed. The patient was started on medroxyprogester...
Massive Catamenial Hemothorax: Rare Case of Thoracic Endometriosis Syndrome
https://www.ijhsr.org/IJHSR\_Vol.11\_Issue.1\_Jan2021/IJHSR\_Abstract.030.html, 2021
Spontaneous hemothorax is only rarely due to thoracic endometriosis (TE). TE is presence of ectopic endometrial tissue in thoracic. It is rare phenomena seen in women of childbearing age with predominantly right-sided hemothorax and temporal relationship to menses. We report a thirty-seven-year-old Omani lady who was admitted in Sultan Qaboos hospital, Salalah with Spontaneous hemothorax and dysmenorrhea. She had past history of primary infertility due to endometriosis and she lost follow up. Therefore, TE was suspected and was introduced hormone therapy after chest drain inserted. She had recurrent hemothorax after discharge subsequently, she underwent VATS which help visualization of endometrial lesions with pleurectomy of the involved areas and mechanical decortication and pleurodesis using scratch pad were done. Histopathology confirms diagnosis of TE. She continued hormonal therapy and repeated image showed no recurrence.
Lung, 1985
Pulmonary endometriosis is manifested as either asymptomatic pulmonary nodules or as pneumothorax, hemothorax, or hemoptysis during menses. We review 84 cases of pulmonary endometriosis in the English literature and report 3 additional patients. One of our patients is the first reported to have hemopneumothorax. Catamenial pneumothorax usually involved the right chest, and occurred in young nulliparous women without pelvic endometriosis. Pleuroscopy, laparoscopy with pneumoperitoneum, and thoracotomy produced a tissue diagnosis infrequently. Hormonal suppression of ovulation and pleurodesis usually corrected this disorder. Catamenial hemothorax only affected the right chest, but occurred in older multiparous women with pelvic endometriosis. While thoracotomy or laparotomy produced a tissue diagnosis, these procedures were not curative. In contrast, our patient with this disorder was treated successfully with pleurectomy. Catamenial hemoptysis occurred in multiparous women without pelvic endometriosis. Bronchoscopy localized bleeding but never produced a tissue diagnosis. Thoracotomy produced endometrial tissue. Endometrial pulmonary nodules require a diagnosis but do not otherwise produce problems.
Thoracic endometriosis syndrome, not so rare; report of 3
2013
Endometriosis is presence of functional endometrial glands and stroma outside the uterine cavity. It is usually confined to the pelvis, and therefore thoracic endometriosis syndrome (TES) is regarded as a rare disorder characterized by the presence of functioning endometrial tissue in the pleura, the lung parenchyma and/or the airways. TES may therefore present with catamenial hemoptysis, due to the shedding of endometrial tissue in the bronchial tree, or catamenial pneumothorax or hemothorax if the endometrial tissue is localized peripherally. We report our three consecutive patients diagnosed as TES in the first three years of our new cardiothoracic surgery unit. All three patients' diagnosis was established clinically based on cyclicity of symptoms with temporal relationship with menstrual period in appropriate patients. Patient 1 had left catamenial pneumothorax, patient 2 had right catamenial hemo-pneumothorax and left catamenial hemothorax, while patient 3 had right catamenial hemothorax. Pleural aspirates for cytology and percutaneous pleural biopsies failed to establish the histologic diagnosis. Treatment consisted of closed tube thoracostomy drainage, analgesic, prophylactic antibiotic, chest physiotherapy, whole blood transfusion in two patients, and chemical pleurodesis using either tetracycline or cyclophosphamide injection. Failure of pleurodesis in one pleural space necessitated hormonal therapy with goserelin injection. We advise a high index of suspicion which may enable case findings to disprove the 'rarity' of TES.