Endometriosis-associated pneumothoraxes

Background: Endometriosis involves the pelvic organs in the vast majority of cases; the extragenital location of endometrioid tissue is found more rarely, in nearly 12.9% of cases. One of the most common and simultaneously life-threatening forms of extragenital endometriosis is thoracic endometriosis (TE) that includes the foci localized on the pleura, diaphragm and in lung tissue. Case report: A 48-year-old female patient P. complained of recurrent catamenial pneumothorax. She underwent pleural drainage, video-assisted thoracoscopy, resection of the tendon center of the diaphragm, and costal pleurectomy. Endometriosis of the diaphragm dome was diagnosed on the basis of the histological findings; gonadotropin-releasing hormone agonists were used for 6 months, followed by a switch to dienogest until menopause. A 37-year-old female patient D. underwent chest and abdominal MRI for recurrent chest pain and dyspnea on the days of menstruation; however, no signs of endometriosis were found. Subsequent thoracoscopy revealed pleural endometriosis. When she joined the ART program, the patient was decided not to receive hormonal therapy because recurrent pneumothorax occurred after 3 months. Conclusion: TE is a rare disease, the prevalence and pathogenesis of which are not fully understood. Since the diagnosis of the disease is often difficult; its treatment may be delayed; in view of that life-threatening pneumothorax may recur. A high clinical suspicion by therapists, pulmonologists, surgeons, and gynaecologists/ endocrinologists is needed for timely diagnosis and better quality of life in patients with TE.

extragenital, thoracic, diaphragmatic, and catamenial endometriosis, pneumothorax, hormonal therapy, IVF, ART