Thoracic endometriosis syndrome at University of Ilorin Teaching Hospital

Abstract

Background. Endometriosis is defined as the presence of endometrial tissue (stroma and functional glands) outside the uterine cavity in women of reproductive age. Ectopic sites are frequently located in the pelvis; extrapelvic sites have been reported in the gastrointestinal tract and thoracic cavity. Thoracic manifestation of endometriosis constitutes thoracic endometriosis syndrome (TES). Objectives. To examine the presentation pattern and outcome of in the management of TES. Methods. This study is a retrospective review of medical records of patients diagnosed with endometriosis at the University of Ilorin Teaching Hospital over a 3.5-year period from January 2014 to June 2017. Results. A total of 21 patients presented with endometriosis, of whom 8 (38.1%) presented with TES. The most common variety of TES was catamenial pleural effusion (CPE) accounting for 75%, followed by catamenial chest pain (37.5%). Two patients (25%) each presented with catamenial pneumothorax and catamenial haemoptysis, while 1 (12.5%) had catamenial surgical emphysema. Closed thoracostomy tube drainage plus chemical pleurodesis was the most frequent intervention technique, accounting for 62.5%. Conclusion. TES remains an uncommon entity, despite being the most common extrapelvic manifestation of endometriosis. CPE appeared to be the most common variant of TES in our environment. Currently available treatment options need to be improved, and more use made of video-assisted thoracoscopic surgery.

Thoracic endometriosis syndrome: Cutting the gordian knot – A case report and review of the literature

“…Our patient had a CA-125 level of 55.5 u/ml at presentation. The disadvantage of CA-125 is that its levels in the serum or pleura fluid can be increased by any irritation to the mesothelial cells [15]. The gold standard for the diagnosis remains video-assisted thoracoscopic surgery (VATS) because it allows for the direct visualization of the lung and pleural surfaces for endometrial tissue implants [10,14,15].…”

“…In many low resource settings, VATS may be unavailable, and open thoracotomy should be employed. Treatment with chemical pleurodesis alone is associated with a very high rate of recurrence due to continuous migration of endometrial tissue through diaphragmatic defects into the thorax when such defects are not closed [3,15,18]. While surgical therapy has been found to be more effective at preventing recurrence than hormonal therapy [16], combination of both surgical and hormonal therapies have been associated with no recurrence in a follow up period of up to 45 months [14].…”

Clinical Manifestations of Endometriosis in the Respiratory System - Available Diagnostic Methods

“…Some studies suggest that immunohistochemistry estrogen/progesterone receptors and CD10 -positive might be necessary for diagnosis. In addition, pleural fluid analysis may also be helpful in confirming the diagnosis [7][8] [9].…”