Thoracic Endometriosis Syndrome

Abstract

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity and is usually confined to the pelvis. Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of functioning endometrial tissue in the pleura, the lung parenchyma and the airways. TES may present with hemoptysis, due to the shedding of endometrial tissue in the bronchial tree, or spontaneous pneumothorax or hemothorax if the endometrial tissue is localized peripherally. Patients are of reproductive age, often nulliparous, with long-standing symptoms. The crucial issue for establishing the diagnosis is the cyclicity of the symptoms which occur along with the menstrual cycle. TES is virtually a diagnosis of exclusion, established on clinical grounds, since neither CT nor endoscopy are specific for TES. Treatment consists of gonadotropin-releasing hormone analogues, aiming to suppress the hypophyseal-gonadal axis, so as to ensure a regression of the endometrial implants. If medical treatment fails, surgical resection of the endometriomas is suggested, although relapse rate may be high.

Nocturnal Hypoxemia, an Unusual Presentation of Pulmonary Endometriosis: A Case Report

“…Interestingly, the manifestations of TES, except for nodules, occurred more commonly in the right hemithorax, clearly an unexplained phenomenon that continues to elude all investigators [2,3]. Diagnosis is usually delayed until several episodes have occurred because of failure to associate the patient's symptoms with menses [7]. Computed tomography scan, unless obtained during menses, may be unremarkable [7].…”

“…Diagnosis is usually delayed until several episodes have occurred because of failure to associate the patient's symptoms with menses [7]. Computed tomography scan, unless obtained during menses, may be unremarkable [7]. Although histopathological detection of thoracic endometrial tissue is generally not required, diagnosis was established in some cases by pleural fluid cytology, needle biopsy of lung masses, and cytological study of bronchoscopic fluid [8][9][10].…”

“…Once the patient has been stabilized, hormonal manipulation is generally recommended as the first line therapy, but recurrence rates are high. When hormonal therapy fails or is not tolerated, surgical therapies should be considered [7].…”

Thoracic endometriosis with catamenial haemoptysis and pneumothorax: computed tomography findings and long-term follow-up after danazol treatment

“…(1,2) TE is characterised by the presence of functioning, morphologically normal endometrial tissues in the pleura, diaphragm, lung parenchyma and/or airways. (1)(2)(3)(4) Depending on the affected sites, patients…”

“…All of these preferentially involve the right hemithorax. (1)(2)(3)(4)(5)(6) CP is the most common clinical manifestation, accounting for approximately 70%-80% of TE cases. CH and CHt individually account for 7%-14% of TE.…”