Medical thoracoscopy in thoracic endometriosis: a diagnostic tool in a rare scenario

Nashin Najeeb; Athul Thulasi; Rajathilakam Natarajan Kumari; Kiran Jose; Angel Varghese

doi:10.18203/2320-6012.ijrms20261714

Authors

Nashin Najeeb Department of Pulmonology, Travancore Medical College, Kollam, Kerala, India
Athul Thulasi Department of Pulmonology, Travancore Medical College, Kollam, Kerala, India
Rajathilakam Natarajan Kumari Department of Pulmonology, District Hospital, Kollam, Kerala, India
Kiran Jose Department of Pathology, Travancore Medical College, Kollam, Kerala, India
Angel Varghese District Hospital Kollam, Kerala, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20261714

Keywords:

Thoracic endometriosis syndrome, Catamenial pneumothorax, Medical thoracoscopy, Pleural endometriosis, Secondary infertility, Hormonal and surgical management

Abstract

Medical thoracoscopy is a tool employed in the evaluation of pleural effusions when initial diagnostic thoracocentesis and standard conventional therapies prove to be ineffective. Thoracic endometriosis (TE) is an uncommon form of extra pelvic endometriosis, characterized by endometrial cells in thoracic cavity which can be parenchymal, pleural and diaphragmatic. TE typically manifest as catamenial pneumothorax followed by catamenial hemothorax, catamenial hemoptysis and occasionally as pulmonary nodules. We present a case involving a 29 year old female experiencing secondary infertility and recurrent right sided chest pain and dyspnea since three months. Chest radiography revealed right hydropneumothorax. As her symptoms correlated cyclically with menstruation, a high suspicion of TE was made and later confirmed on histopathology by medical thoracoscopy.

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References

Agarwal N, Subramanian A. Endometriosis-morphology, clinical presentations and molecular pathology. J Lab Physicians. 2010;2(1):1-9. DOI: https://doi.org/10.4103/0974-2727.66699

Vinatier D, Orazi G, Cosson M, Dufour P. Theories of endometriosis. Eur J Obstet Gynecol Reprod Biol. 2001;96(1):21-34. DOI: https://doi.org/10.1016/S0301-2115(00)00405-X

Alifano M, Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge. Ann Thorac Surg. 2006;81(2):761-9. DOI: https://doi.org/10.1016/j.athoracsur.2005.07.044

Joseph J, Sahn SA. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med. 1996;100(2):164-70. DOI: https://doi.org/10.1016/S0002-9343(97)89454-5

Channabasavaiah AD, Joseph JV. Thoracic endometriosis: revisiting the association between clinical presentation and thoracic pathology based on thoracoscopic findings in 110 patients. Medicine (Baltimore). 2010;89(3):183-8. DOI: https://doi.org/10.1097/MD.0b013e3181df67d5

Sampson JA. Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol. 1927;14:422-69. DOI: https://doi.org/10.1016/S0002-9378(15)30003-X

Alifano M, Roth T, Broët SC, Schussler O, Magdeleinat P, Regnard JF. Catamenial pneumothorax: a prospective study. Chest. 2003;124(3):1004-8. DOI: https://doi.org/10.1378/chest.124.3.1004

Makhija Z, Marrinan M. A case of catamenial pneumothorax with diaphragmatic fenestrations. J Emerg Med. 2012;43(1):e1-3. DOI: https://doi.org/10.1016/j.jemermed.2009.05.023

Maurer ER, Schaal JA, Mendez FL Jr. Chronic recurring spontaneous pneumothorax due to endometriosis of the diaphragm. JAMA. 1958;168(15):2013-4. DOI: https://doi.org/10.1001/jama.1958.63000150008012c

Fukunaga M. Paratesticular endometriosis in a man with prolonged hormonal therapy for prostatic carcinoma. Pathol Res Pract. 2012;208(1):59-61. DOI: https://doi.org/10.1016/j.prp.2011.10.007

Joseph J, Reed CE, Sahn SA. Thoracic endometriosis: recurrence following hysterectomy with bilateral salpingo-oophorectomy and successful treatment with talc pleurodesis. Chest. 1994;106(6):1894-6. DOI: https://doi.org/10.1378/chest.106.6.1894

Nwiloh J. Diaphragmatic patch: a useful adjunct in surgical treatment of recurrent catamenial hemothorax. Rev Port Pneumol. 2011;17(6):278-80. DOI: https://doi.org/10.1016/j.rppnen.2011.11.006

Hibbard LT, Schumann WR, Goldstein GE. Thoracic endometriosis: a review and report of two cases. Am J Obstet Gynecol. 1981;140(2):227-32. DOI: https://doi.org/10.1016/0002-9378(81)90112-5

Chatterjee S, Mukhoti K, Chakraborty A. Catamenial pneumothorax in thoracic endometriosis syndrome. Lung India. 2024;41(3):217-8. DOI: https://doi.org/10.4103/lungindia.lungindia_576_23

Sharma P, Karmakar S, Wani AR, Venugopal V, Maji D. Thoracic endometriosis syndrome diagnosed by dry thoracoscopy: Novel diagnostic method for a rare disease. Lung India. 2025;42(2):147-50. DOI: https://doi.org/10.4103/lungindia.lungindia_576_24

Hope-Gill B, Prathibha B. Catamenial haemoptysis and clomiphene citrate therapy. Thorax. 2003;58(1):89. DOI: https://doi.org/10.1136/thorax.58.1.89

Chetambath R, Karedath G, Chandran S. Thoracic Endometriosis Detected During Medical Thoracoscopy in a Tertiary Care Setting-A Retrospective Observational Study. J Pulmonol Res Rep. 2024;6(4):1-4. DOI: https://doi.org/10.47363/JPRR/2024(6)172

Nezhat C, Nicoll LM, Bhagan L, Huang JQ, Bosev D, Hajhosseini B, et al. Endometriosis of the diaphragm: four cases treated with a combination of laparoscopy and thoracoscopy. J Minimally Invas Gynecol. 2009;16(5):573-80. DOI: https://doi.org/10.1016/j.jmig.2009.06.012

Light RW. Pleural disease. 5th edition. Lippincott Williams and Wilkins: Baltimore. 2007.