ReviewThoracic Endometriosis: Current Knowledge
Section snippets
Material and Methods
Literature searches were carried out using Medline for articles published up to December 2004 containing the associations of words “catamenial pneumothorax,” “catamenial hemothorax,” “catamenial hemoptysis,” “pneumothorax endometriosis,” “hemothorax endometriosis,” “hemoptysis endometriosis,” “lung nodule endometriosis,” “thoracic endometriosis,” “diaphragmatic endometriosis,” “pulmonary endometriosis,” “bronchial endometriosis,” and “pleural endometriosis.” We also reviewed the references from
Epidemiology
Endometriosis is thought to affect 5% to 15% of women in reproductive age [1]. Clinical and radiologic manifestations of thoracic endometriosis are generally thought to be extremely rare, but specific figures are scanty and come almost completely from case reports and small retrospective series. The most consistent, albeit retrospective, series on TES included 110 patients and showed that the mean age at presentation was 35 ± 0.6 years, with a range from 15 to 54 years [5]. Interestingly, the
Etiologic Mechanisms
There is general agreement that thoracic endometriosis is the only cause of CHt [11], CH [12, 13], and of the exceedingly rare endometriotic lung nodules [5]. Catamenial pneumothorax, although very frequently associated with thoracic endometriosis, may also have other etiological mechanisms [5, 8]. The clinical manifestations of CHt, CH, and endometriosis-related pneumothorax imply the presence of intrathoracic endometrial tissue undergoing cyclical changes in response to the physiologic
Pathology
Thoracic endometriosis is represented by the presence of morphologically normal endometrial tissue within the thoracic cavity (Fig 3, Fig 4). Regardless of the site, endometriotic foci consist of both stroma and glands in different proportions, often with ectatic glands, mostly lined by pseudostratified cuboidal to cylindrical epithelium. Flieder and colleagues [35] provided a definite description of nine cases of pleuropulmonary endometriosis. They described the presence of proliferative-type
Clinical Presentations
Catamenial pneumothorax is the most frequent presentation of TES, accounting for approximately 80% of cases [5]. Catamenial pneumothorax is generally defined as a recurrent pneumothorax occurring within 72 hours after the onset of menstruation [8], but somewhat different time frames are possible. There are reports of recurrence in relation to the immediate premenstrual period [24, 38] and the ovulatory phase [39]. Furthermore, recurrent endometriosis-related pneumothorax may also be observed in
Diagnosis
In accordance with the preferential peripheral location of endometrial tissue in the lung of patients with CH, bronchoscopy does not show visible lesions in most cases [12, 18, 19, 46, 47], although it frequently allows localization of the bleeding lobe or segment [12, 46, 47]. Descriptions of bronchoscopic findings are, therefore, extremely rare with fewer than 10 cases having been reported [48, 51, 52, 53, 55, 56]. Multiple, bilateral purplish-red submucosal lesions, which ooze easily if
Treatment
In the era of video-assisted surgery, treatment of TES is best achieved by video-assisted thoracoscopy. Once the pathogenic mechanism has been identified by exploration, targeted treatment may be carried out in most instances [8]. Diaphragmatic involvement by either endometrial tissue or perforations is probably best managed by diaphragmatic resection [8]. Simple suturing of the holes has been reported to be followed by recurrence [64], and it does not provide tissue for diagnosis. What is
Outcome
Information about the outcome of manifestations of thoracic endometriosis are scanty and have significant limitations because they are derived from case reports or small series, and refer to short-term follow-up periods. That is especially true for CH and CHt, whereas the outcome of CP is better known. Bagan and colleagues [24] reported the outcome of a retrospective series of 10 patients who were followed up for a mean period of 55.7 months: the recurrence rate among patients treated by simple
References (70)
- et al.
Laparoscopic excision of endometriosisa randomized, placebo-controlled trial
Fertil Steril
(2004) - et al.
Thoracic endometriosis syndromenew observations from an analysis of 110 cases
Am J Med
(1996) - et al.
Epidemiology of spontaneous pneumothorax in women
Chest
(1986) - et al.
Catamenial pneumothorax. A prospective study
Chest
(2003) - et al.
Right-sided hemothorax and recurrent abdominal pain in a 34-year-old woman
Chest
(1993) - et al.
Catamenial hemoptysis. Diagnosis with MRI
Chest
(1997) - et al.
Catamenial pneumothorax
Chest
(1990) - et al.
A case of endobronchial endometriosis treated by subsegmentectomy
Chest
(1999) Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity
Am J Obstet Gynecol
(1927)- et al.
Catamenial pneumothorax revisitedclinical approach and systematic review of the literature
J Thorac Cardiovasc Surg
(2004)
Catamenial pneumothoraxretrospective study of surgical treatment
Ann Thorac Surg
Endometriosis-related pneumothoraxclinico-pathological observations from a newly diagnosed case
J Thorac Cardiovasc Surg
Recurrent spontaneous pneumothorax concomitant with menstruation
J Thorac Cardiovasc Surg
Catamenial pneumothoraxchest X-ray sign and thoracoscopic treatment
Ann Thorac Surg
Catamenial pneumothorax caused by endometriosis in the visceral pleura
Ann Thorac Surg
Pleuro-pulmonary endometriosis and pulmonary ectopic deciduosisa clinico-pathologic and immunohistochemical study of 10 cases with emphasis on diagnostic pitfalls
Hum Pathol
Video-assisted thoracoscopic surgery for catamenial hemoptysis
Chest
Diaphragmatic endometriosisdiagnosis, surgical management, and long-term results of treatment
Fertil Steril
Catamenial pneumothorax associated with endometriosis of the diaphragm
Chest
A unique case of catamenial pneumothorax
Chest
Thoracic endometriosis recurrence following hysterectomy with bilateral salpingo-oophorectomy and successful treatment with talc pleurodesis
Chest
Thoracic endometriosisa case report and literature review
J Thorac Cardiovasc Surg
Catamenial hemoptysis. New methods of diagnosis and therapy
Chest
Utility of angiograms in patients with catamenial hemoptysis
Chest
Successful endoscopic Nd-YAG laser treatment of endobronchial endometriosis
Chest
Catamenial hemoptysis from tracheobronchial endometriosisreappraisal of diagnostic value of bronchoscopy and bronchial brush cytology
Chest
Laparoscopic surgical management of diaphragmatic endometriosis
Fertil Steril
Catamenial haemoptysis from endobronchial endometriosis. A case report and review of previously reported cases
Respir Med
Visualization of diaphragmatic fenestration associated with catamenial pneumothorax
Ann Thorac Surg
Catamenial pneumothorax
Chest
Catamenial pneumothorax caused by diaphragmatic endometriosis
J Thorac Cardiovasc Surg
Catamenial pneumothorax in sisters
Chest
Hemothorax associated with endometriosis
J Thorac Cardiovasc Surg
Catamenial pneumothoraxa multifactorial etiology
J Thorac Cardiovasc Surg
Very low dose danazol for relief of endometriosis-associated pelvic paina pilot study
Fertil Steril
Cited by (197)
In endometriosis-related pneumothorax surgery, presence of endometriotic nodules increases postoperative air leaks and long-term relapse
2024, European Journal of Obstetrics and Gynecology and Reproductive BiologyA typical but rare cause of hemoptysis
2023, European Journal of Internal MedicineTrue Prevalence of Diaphragmatic Endometriosis and Its Association with Severe Endometriosis: A Call for Awareness and Investigation
2023, Journal of Minimally Invasive GynecologyThoracic endometriosis masquerading as Meigs' syndrome in a young woman: A case report and literature review
2022, Case Reports in Women's HealthCatamenial hemothorax: Results of 11 operated cases
2022, Revue des Maladies RespiratoiresTreatment of Thoracic Endometriosis Syndrome: A Meta-Analysis and Review
2022, Annals of Thoracic Surgery