Clinical features of thoracic endometriosis: A single center analysis

Abstract

ObjectiveTo analyze the diagnostic profiles and treatment outcomes of patients with thoracic endometriosis at a university hospital.MethodsA retrospective review of medical records was performed for patients diagnosed with thoracic endometriosis at Gangnam Severance Hospital, Yonsei University College of Medicine, between January 2007 and January 2014.ResultsFifteen patients (median age, 35 years; range, 23-48 years) were evaluated. Patients presented with catamenial hemoptysis (n=8), or catamenial pneumothorax (n=7). Patients with catamenial pneumothorax were significantly older than those presenting with hemoptysis (P=0.0002). Only 3 patients (20%) had coexisting pelvic endometriosis. All patients underwent chest computed tomography; lesions were shown to predominantly affect the right lung (right lung, n=13, 86.7%; left lung, n=2, 13.3%), and were mainly distributed on the right upper lobe (n=9, 60%). Ten patients underwent video-assisted thoracoscopic surgery, and 1 patient underwent a thoracotomy. Intraoperatively, endometriosis-specific findings were observed in 8/11 patients (72.7%); a further 5/11 patients (45.4%) had histologically detectable endometriosis. Over the follow-up period (mean, 18.4 months; range, 2-65 months) 5/15 patients (33%) had clinical signs of recurrence. Recurrence was not detected in any of the 5 catamenial pneumothorax patients that received adjuvant hormonal therapy after surgery.ConclusionThe diagnosis and management of thoracic endometriosis requires a multidisciplinary approach, based upon skillful differential diagnosis, and involving careful gynecologic evaluation and assessment of the cyclicity of pulmonary symptoms. Imaging findings are non-specific, though there may be laterality towards the right lung. Since symptom recurrence is more common in those with presenting with pneumothorax, post-operative adjuvant medical therapy is recommended.

A case report of thoracic endometriosis – A rare cause of haemothorax

“…However, it is important to know that radiological abnormalities are transient [4]. The first line imaging method is CT, but it is poorly specific [16].…”

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“…This case highlights the importance of Thoracoscopy for the rapid diagnosis of TES presenting as an effusion due to its characteristic macroscopic appearances such as red lesions, and endometriotic spots [16]. Early Thoracoscopy has an additional advantage of providing the option for draining pleural fluid completely without leaving any radiological stigmata such as pleural thickenings.…”

“…CECT thorax is a very useful investigation in this context. Thoracic imaging seems less useful as a definitive diagnostic tool in the diagnosis of TES as it does not have a characteristic radiological pattern [16]. In an endemic area where latent tuberculosis is common, it is mandatory to exclude active tuberculosis by other investigations in the presence of a significantly positive Mantoux reading.…”

Pulmonary Endometriosis: A Review

“…Imaging techniques may be non-specific. 13 The diagnosis can be difficult to make. 4 A chest x-ray or computed tomography (CT) can reveal multiple lung nodules, 14 if these are present.…”

“…Immediately after surgical treatment, medical therapy must be started 4,13 as recurrence is common since the endometrial tissue will be responsive to ovarian hormones.…”