Roberts, L. M., Redan, J., & Reich, H. (2003). Extraperitoneal endometriosis with catamenial pneumothoraces: a review of the literature. JSLS : Journal of the Society of Laparoendoscopic Surgeons, 7(4), 371-375.
Roberts LM, Redan J, Reich H. Extraperitoneal endometriosis with catamenial pneumothoraces: a review of the literature. JSLS. 2003;7(4):371-375.
Roberts, Lisa M., et al. "Extraperitoneal endometriosis with catamenial pneumothoraces: a review of the literature." JSLS : Journal of the Society of Laparoendoscopic Surgeons, vol. 7, no. 4, 2003, pp. 371-375.
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Advanced Gynecology Endoscopic Surgery, Kingston, Pennsylvania, USA.
RRM Academy Synopsis
Endometriosis in the chest may cause lung collapse with periods
A case report with a literature review describes a woman of 28 whose endometriosis in the diaphragm and lung caused a collapsed lung that came with her periods. Surgeons excised the lesion and resected a wedge of lung thoracoscopically. A second collapse five months after her pelvic excision needed a thoracoscopic pleurectomy.
Key Findings
In the review, 75% of pulmonary endometriosis appears as catamenial pneumothorax. Cyclical hemothorax accounts for 10.7%, and hemoptysis for 8.3%.
The woman's chest pain came monthly on the right side and was associated with her menses. She also had bloody stools, chronic constipation and pelvic pain.
At thoracoscopy, a 1.5-cm x 1.0-cm lesion sat on the right hemidiaphragm. That lesion and a bleb-bearing wedge of lung both held endometrial glands and stroma.
Three months after the chest operation she had laparoscopic excision of pelvic endometriosis with a low anterior rectal resection. Five months on, a recurrent pneumothorax needed a thoracoscopic right total pleurectomy.
Interpretation
The paper is one case report with a narrative literature review from 2003. The review calls the route of air into the chest controversial. Diaphragmatic fenestrations appear in only 19% to 33% of patients with catamenial pneumothorax. The authors judge the coelomic metaplasia theory the most plausible explanation for endometriosis outside the pelvis. They write that drug therapies suppress endometriosis and leave the disease in place, and that going straight to surgery is not unreasonable.
RRM Context
Chest pain that followed her menses pointed to the diagnosis, so symptom timing across the cycle served as a clue. Restorative reproductive medicine looks for the root cause and treats it. The authors' view that drugs suppress endometriosis while surgical resection removes lesions fits that principle and the excision standard.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To present a case of recurrent catamenial pneumothorax and diaphragmatic endometriosis that was managed thoracoscopically. A review of the literature is also presented.
Methods
A-28-year-old woman presented with bloody stools, chronic constipation, and chest pain. A review of systems was positive for monthly chest pain associated with her menses. A preoperative chest x-ray revealed a right pneumothorax. Colonoscopy revealed biopsy proven endometriosis of the sigmoid colon. A pelvic computed tomography scan revealed bilateral complex, cystic and solid adenexal lesions.
Results
A right thoracoscopy was performed. A lesion on the right hemidiaphragm was excised and confirmed to be endometriosis. A wedge section of lung tissue containing a bleb was resected and also contained endometriosis. Three months later, the patient underwent laparoscopic excision of her pelvic endometriosis, including a low anterior rectal resection. Five months later, she presented again with right-sided chest pain. A thoracoscopic right total pleurectomy was performed for recurrent pneumothorax.
Conclusion
Pullmonary endometriosis may present as chest pain, shortness of breath, or hemoptysis associated with menstrual cycles. This case emphasizes the importance of a careful review of systems in patients with known endometriosis. Management now includes an endoscopic alternative and all of its known benefits.
