Diaphragmatic endometriosis and thoracic endometriosis syndrome: a review on diagnosis and treatment

Abstract

Endometriosis of the diaphragm has been gaining more attention in the practice of gynecologists and thoracic surgeons in recent years. Understanding related symptoms and developing imaging methods have improved their approach. A review of the literature was performed with the aim to report on incidence, diagnosis, treatment and prognosis of diaphragmatic endometriosis. We also cover the issue of the Thoracic Endometriosis Syndrome (TES). Complaints of cyclic chest pain in patients of childbearing age should have as differential diagnosis the presence of thoracic endometriosis. Catamenial pneumothorax is the main manifestation of diaphragmatic endometriosis and Thoracic Endometriosis Syndrome. Other possible manifestations are hemothorax, pulmonary nodules, and diaphragmatic hernia. Despite the possibility of drug treatment, many patients will be submitted to surgical treatment. The minimally invasive approach should be the one of choice. The robotic pathway allows for an easier approach due to its ability to articulate robotic arms, allowing the treatment of lesions in hard-to-reach locations, such as the posterior part of the diaphragm. Multidisciplinary treatment should be used in most cases, as only abdominal approach is not sufficient for the diagnosis and treatment of lesions in the thoracic cavity. The approach of endometriosis of the diaphragm and Thoracic Endometriosis Syndrome should be multidisciplinary, allowing the improvement of quality of life in most patients.

Thoracic endometriosis presenting as hemopneumothorax

“…A multidisciplinary approach to her disease including management by thoracic surgery and gynecology has been shown to improve outcomes and decrease recurrence [8,9]. For recurrent disease, VATS is preferred along with occasional concomitant laparoscopy to evaluate abdominal tumor burden [1,2,7,9].…”

“…A multidisciplinary approach to her disease including management by thoracic surgery and gynecology has been shown to improve outcomes and decrease recurrence [8,9]. For recurrent disease, VATS is preferred along with occasional concomitant laparoscopy to evaluate abdominal tumor burden [1,2,7,9]. Due to the non-significant transvaginal ultrasound, the patient underwent only VATS without laparoscopy with plans to manage the abdominal disease with hormonal therapy.…”

“…In refractory cases to tube thoracostomy drainage and hormonal suppressive therapy, video-assisted thoracoscopic surgery (VATS) with resection, pleurodesis and diaphragmatic repair might be curative [5][6][7][8]. A multidisciplinary approach to TES including coordination between thoracic surgery and gynecology might improve the quality of life and outcomes of affected women [9]. We report a case of TES presenting with recurrent hemopneumothoraces requiring multiple pleural drainage, VATS, and hormonal suppressive therapy.…”

Thoracic and diaphragmatic endometriosis: an overview of diagnosis and surgical treatment

“…Concomitant disease of the diaphragm, pleura and lung was rare and only noted in 1.1% (7/628) of patients [1 ▪▪ ,8 ▪ ]. In 80–90% of patients with thoracic endometriosis, lesions will be seen on the right [1 ▪▪ ,8 ▪ ].…”

“…Less commonly, isolated thoracic endometriosis can affect the pleura (12.7% of patients, 80/628) and the lung (4.5% of patients, 28/628) [1 ▪▪ ]. Concomitant disease of the diaphragm, pleura and lung was rare and only noted in 1.1% (7/628) of patients [1 ▪▪ ,8 ▪ ]. In 80–90% of patients with thoracic endometriosis, lesions will be seen on the right [1 ▪▪ ,8 ▪ ].…”