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.

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. Similar content being viewed by others Abbreviations - CT: - Computed tomography - MRI: - Magnetic resonance imaging - RLL: - Right lower lobe - RUQ: - Right upper quadrant - VATS: - Video-assisted thoracoscopic surgery

Not applicable. Prior presentation This case was previously presented at the CHEST 2025 Annual Meeting on Oct 22, 2025 in Chicago, IL in the form of a poster presentation. Funding The authors received no specific funding for this work. Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate According to institutional policy, ethical approval was not required for this case report as it describes a single patient and does not involve research interventions. The study was conducted in accordance with institutional ethical standards and the Declaration of Helsinki. Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. About this article Cite this article Gochi, A.M., Williams, K.M., Kimura, M.M. et al. Definitive diagnosis and surgical management of pleural and diaphragmatic endometriosis: a case report. J Cardiothorac Surg (2026). https://doi.org/10.1186/s13019-026-04266-8 Received: Accepted: Published: DOI: https://doi.org/10.1186/s13019-026-04266-8