Thoracic Endometriosis Syndrome: A Veritable Pandora's Box

Abstract

Thoracic endometriosis syndrome is a rare disorder characterised by the presence of functioning endometrial tissue in pleura, lung parenchyma, airways, and/or encompasses mainly four clinical entities-catamenial pneumothorax, catamenial haemothorax, catamenial haemoptysis and lung nodules. The cases were studied retrospectively by reviewing the records at Amrita Institute of Medical Sciences, for duration of five years i.e., form March 2010-2014 and analysed for the clinical presentation and management of thoracic endometriosis syndrome. Catamenial breathlessness was the main symptom. Pneumothorax and pleural effusion were the findings on investigations. Histopathology report of endometriosis was present in three cases (50%). Conditions with excess oestrogen like endometriosis, fibroid, adenomyosis were diagnosed in these patients by pelvic scan. After the initial supportive treatment with hormones, pleurodesis, hysterectomy and lung decortication were the treatment modalities. Two cases that had multiple recurrences were diagnosed as disseminated TES. They underwent combined treatment of surgery and hormones.

Keywords: Catamenial pneuothorax; Pleural biopsy; Pleural effusion; Pleurodesis; Thoracoscopy; Video assissted thoracoscopic surgery.

[Table/Fig-1]:

CT Scan–Bilateral Pleural Effusion.

[Table/Fig-2]:

Right Pneumothorax.

[Table/Fig-3]:

CT Scan–Right Pneumothorax with ICD Tube.

[Table/Fig-4]:

CT Scan–Right Sided Pneumothorax with Collapse of Posterior Basal Segment on Right Side (Drainage Tube Insitu).

[Table/Fig-5]:

CXR–Lung Colapse with Right Pneumothorax with ICD Tube.

[Table/Fig-6]:

CT Scan–Pneumothorax with Pleural Endometriosis (Plaque Like Lesion).

[Table/Fig-7]:

Right Side Pleural Effusion.

[Table/Fig-8]:

CT Abdomen-Apple Core Lesion in Sigmoid Colon.

[Table/Fig-9]:

Pleural Biopsy Suggestive of Endometriosis.

[Table/Fig-10]:

CT SCan–Right Pleural Effusion with Collapse of the Underlying Lung.

[Table/Fig-11]:

CT Scan Left Pleural Effusion.