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Endometriosis · Associated Conditions

Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management

Nezhat C, Lindheim SR, Backhus L, Vu M, Vang N, Nezhat A, Nezhat C

JSLS : Journal of the Society of Laparoendoscopic Surgeons, 23(3), 2019
DOI 10.4293/JSLS.2019.00029 PMID 31427853 PMC PMC6684338

RRM Academy Synopsis

Thoracic endometriosis usually appears alongside pelvic disease

A 2019 review of published reports finds that among women diagnosed with endometriosis in the chest, about 5 to 8 out of 10 also have pelvic endometriosis. Some women have a collapsed lung or chest bleeding timed to their periods. When medicine fails or cannot be used, the authors favor combined surgery by a gynecologic surgeon and a chest surgeon.

Key Findings

  • Among patients diagnosed with thoracic endometriosis syndrome, 50%–84% have concomitant pelvic endometriosis.
  • Mean age at presentation is 35 y with thoracic endometriosis versus 25 to 30 y with pelvic disease only. Patients typically have pelvic symptoms about 5–7 y earlier.
  • Symptomatic patients present with catamenial pneumothorax (80%), catamenial hemothorax (14%), or catamenial hemoptysis (5%).
  • Endometriosis is nine times more likely on the right hemidiaphragm than on the left.
  • In the largest review of catamenial pneumothorax, 52.1% were diagnosed with thoracic endometriosis at thoracoscopic surgery, and 8.5% had no findings.

Interpretation

This is a literature review: the authors searched MEDLINE and PubMed for four keyword sets and synthesized findings from earlier published studies. The authors call the condition rare and say its origin is likely multifactorial. For women with symptoms suggesting the syndrome, they state that combined surgery by a gynecologic surgeon and a chest surgeon gives the most effective outcome. The findings support larger studies of combined surgical approaches for thoracic endometriosis.

RRM Context

Restorative reproductive medicine looks for the cause of disease. The review calls hormone suppression first-line and reports a high recurrence rate after stopping it. Excision is the surgical standard for endometriosis. The authors describe sharp-dissection excision for deeper implants and advise checking the diaphragm at every laparoscopy for suspected pelvic endometriosis. They list a history of infertility among the features that point to the syndrome.

Our editorial summary of this paper, not the article's abstract.

Abstract

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).

Data Sources

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.

Topics

By this author

Related research

Endometriosis › Associated Conditions › Extrapelvic Endometriosis
Camran Nezhat, Steven R Lindheim, Leah Backhus, Mailinh Vu, Nataliya Vang, Azadeh Nezhat, Ceana Nezhat
C Nezhat, Steve Lindheim, S Lindheim, L Backhus, M Vu, N Vang, A Nezhat
PMID 31427853 31427853 DOI 10.4293/JSLS.2019.00029 10.4293/JSLS.2019.00029 Nezhat et al. 2019, Nezhat 2019

Keywords

Catamenial hemoptysis, Catamenial hemothorax, Catamenial pneumothorax, Diaphragmatic. endometriosis, Thoracic endometriosis

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