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Review
. 2019 Jul-Sep;23(3):e2019.00029.
doi: 10.4293/JSLS.2019.00029.

Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management

Camran Nezhat  1 , Steven R Lindheim  2 , Leah Backhus  3 , Mailinh Vu  1 , Nataliya Vang  1 , Azadeh Nezhat  1 , Ceana Nezhat  4
Affiliations
Review

Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management

Camran Nezhat et al. JSLS. 2019 Jul-Sep.

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).

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.

Keywords: Catamenial hemoptysis; Catamenial hemothorax; Catamenial pneumothorax; Diaphragmatic. endometriosis; Thoracic endometriosis.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest directly relevant to the content of this article.

Figures

Figure 1.
Figure 1.
Pleural endometriosis.
Figure 2.
Figure 2.
Acquired diaphragmatic fenestrations secondary to endometriosis.
Figure 3.
Figure 3.
Retraction of the liver edge allows for a more thorough evaluation of the diaphragm.
Figure 4.
Figure 4.
Red lesions involving the left hemidiaphragm.
Figure 5.
Figure 5.
Endometriotic and fibrotic lesions involving the diaphragm.
Figure 6.
Figure 6.
Diffuse endometriosis involving the diaphragm.
Figure 7.
Figure 7.
Advanced-stage diffuse endometriosis of the diaphragm.
See this image and copyright information in PMC

References

    1. Nezhat C, Li A, Abed S, et al. Strong association between endometriosis and symptomatic leiomyomas. JSLS. 2016;20(3). - PMC - PubMed
    1. Nezhat C, Seidman DS, Nezhat F, Nezhat C. Laparoscopic surgical management of diaphragmatic endometriosis. Fertil Steril. 1998;69:1048–1055. - PubMed
    1. Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010;362:2389–2398. - PMC - PubMed
    1. Nezhat C, Falik R, McKinney S, King LP. Pathophysiology and management of urinary tract endometriosis. Nat Rev Urol. 2017;14:359–372. - PubMed
    1. Nezhat C, Li A, Falik R, et al. Bowel endometriosis: Diagnosis and management. Am J Obstet Gynecol. 2018;218:549–562. - PubMed

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