Diagnosis and management of thoracic endometriosis syndrome: Case report

Introduction: While the diagnosis of endometriosis is relatively common, thoracic endometriosis is a rare manifestation. Thoracic Endometriosis Syndrome (TES) most commonly presents with pneumothorax, 3% which are bilateral, making this case unique in the already limited breadth of TES with catamenial hemopneumothorax. Additionally, this patient had laboratory values constant with ovarian suppression yet continued menses and recurrent hemopneumothorax, necessitating surgical intervention. We propose that with this severity of disease a combination of surgical intervention and hormonal therapy is the ideal approach, providing the lowest rate of recurrence. Case description: A 33 year old woman with 2-day history of chest pain and shortness of breath with heavy menstrual cycles and significant dysmenorrhea. A chest radiograph and computed tomography scan revealed right-sided pneumothorax and bilateral hemothoraces with left-sided diaphragmatic hernia. Video-assisted thoracoscopic surgery confirmed sanguinous pleural effusions and biopsy proven endometriotic lesions. The patient was started on a gonadotropin-releasing hormone agonist and experienced short-interval recurrence of her symptoms. An aromatase inhibitor was added to her regimen and she underwent a left diaphragmatic hernia repair. Conclusions: The recurrence of symptoms despite complete hypothalamic-pituitary-ovarian axis suppression, in addition to the surgical requirements and findings make this case unique in the already limited breadth of thoracic endometriosis syndrome with catamenial hemopneumothorax.