Postpartum Thoracic Endometriosis: A Case Report

Abstract

Thoracic endometriosis is a rare disease characterized by the presence of endometrial tissue within the thoracic cavity. Diagnostic findings, symptom presentations, and treatment methods have varied in defining thoracic endometriosis. Most criteria, however, require spontaneous pneumothorax within 72 hours of menses as the sine qua non for this diagnosis. This report describes a case of spontaneous pneumothorax from thoracic endometriosis in a postpartum female, a unique presentation not yet reported in the literature. The patient clinically improved with oxygen via a non-rebreather mask, and no additional intervention was required as the patient clinically improved on her own. Although there are many theories, there is no single theory that fully explains the pathogenesis of this disease. With further research on this disease, there is hope for a better understanding of the etiology and, subsequently, better treatment options.

Keywords: catamenial pneumothorax; endometriosis of the diaphragm; recurrent spontaneous pneumothorax; thoracic endometriosis; thoracic endometriosis syndrome.

Figure 1. Serial chest X-rays.

A: 6/19/24 at 4:09 am: mild pneumothorax on the right side. B: 6/19/24 at 7:58 am: stable-appearing right-sided pneumothorax, right lung atelectatic changes seen with right mild-to-lower lung zone, findings consistent with developing pneumomediastinum seen within the right paratracheal region. C: 6/19/24 at 15:01 pm: persistent right lower lung zone subpulmonic pneumothorax judged to be approximately 15%. Persistent right lower lung zone atelectatic change. (D) 6/19/24 20:22 pm: unchanged small right pneumothorax with underlying atelectasis. Sub-segmental atelectasis left lower lobe. E: 6/20/24 at 6:17 am: small right lower zone pneumothorax. No significant interval change.

Figure 2. Non-contrast chest CT.

6/19/24 at 3:34 am: loculated right pneumothorax in the mid-lower lobe regions with a maximum thickness of 4 cm, associated with adjacent parenchymal collapse. A small loculated pocket of pneumothorax in the right apical region with underlying pneumo-atelectasis. Tiny subpleural parenchymal nodule in the left lower lobe.