Definitive diagnosis and surgical management of pleural and diaphragmatic endometriosis: a case report

BACKGROUND: Thoracic endometriosis is an uncommon and frequently under recognized manifestation of endometriosis involving the pleura, diaphragm, or lung parenchyma. Patients often present with nonspecific cyclical thoracic or upper abdominal pain, and diagnosis is frequently delayed. Surgical management with video-assisted thoracoscopic surgery (VATS) allows definitive diagnosis and surgical management of identified thoracic lesions, particularly when disease spans the thoracic and abdominal cavities. CASE PRESENTATION: A 40-year-old woman with six years of cyclical right upper quadrant pain refractory to hormonal therapy was found to have suspected thoracic and diaphragmatic endometriosis on imaging. Multidisciplinary surgical management with combined VATS and laparoscopy revealed pleural, diaphragmatic, and pelvic endometrial implants, which were completely excised. Pathology confirmed thoracic and pelvic endometriosis. The patient has experienced sustained symptom resolution past 12-month follow-up. CONCLUSIONS: Thoracic endometriosis should be considered in reproductive-age women with unexplained cyclical thoracoabdominal pain. Combined minimally invasive thoracic and abdominal exploration enables comprehensive evaluation and complete resection of disease across the diaphragm, leading to durable symptom control. Early multidisciplinary recognition is essential to optimize outcomes.