Thoracic endometriosis syndrome: Current concept in pathophysiology and management

Abstract

Background : Thoracic endometriosis is a rare pathology. The diagnosis is often delayed or missed, however recently, there has been significant advances in the knowledge of this condition and hence, an improvement in the diagnosis and treatment. Objective : To review the current concepts in the pathophysiology and management of thoracic endometriosis syndrome. Methodology : The main source of information included manual library search and journal publications on PubMed/Medline, Google Scholar, and EMBASE. Results : Many theories have been proposed to explain thoracic endometriosis syndrome, but none of them can fully explain the different manifestations of thoracic endometriosis syndrome (TES) which include catamenial pneumothorax, catamenial haemothorax, catamenial haemoptysis, pulmonary nodule, catamenial pneumomediastinum and isolated chest pain. Radiologic and endoscopic modalities are necessary for making a diagnosis, in addition to a high index of suspicion. Medical treatment traditionally involves the use of oral contraceptive pills, progestational agents, danazol and gonadotrophin releasing hormone analogues. Surgical treatment involves the use of video-assisted thoracoscopy (VAT) or thoracotomy. Conclusion : A multidisciplinary approach is recommended for the optimal  management of TES. Keywords: Catamenial pneumothorax, catamenial  haemoptysis, catamenial haemothorax, pulmonary nodule