Thoracic and Diaphragmatic Endometriosis

Thoracic and diaphragmatic endometriosis are two of the most common sites of extrapelvic endometriosis. Thoracic endometriosis refers to the presence of endometriotic implants within the thoracic cavity, and diaphragmatic endometriosis refers to the endometriotic implants encountered on the abdominal side of the diaphragm. As for thoracic endometriosis, catamenial pneumothorax is the most frequent symptom. The detection of endometrial implants via imaging is challenging, and a definitive diagnosis is typically confirmed through video-assisted thoracoscopic surgery (VATS). Pulmonary parenchymal endometriosis shows nodules, bullous changes, ground-glass opacities, consolidations, and linear opacities. Diaphragmatic endometriosis is often found in the right side with complaints from patients about cyclic right shoulder pain and is often associated with severe pelvic endometriosis. The recommended therapeutic approach for lesions on the abdominal side of the diaphragm involves hydrodissection followed by excision. Because these lesions are tiny punctate foci, they are not easy to recognize on computed tomography (CT) or magnetic resonance (MR) imaging. They can be found as hyperintense nodules or plaques on T1-weighted images on MR imaging. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Andres MP, Arcoverde FVL, Souza CCC, Fernandes LFC, Abrao MS, Kho RM. Extrapelvic endometriosis: a systematic review. J Minim Invasive Gynecol. 2020;27:373–89. Keckstein J, Saridogan E, Ulrich UA, Sillem M, Oppelt P, Schweppe KW, Krentel H, Janschek E, Exacoustos C, Malzoni M, Mueller M, Roman H, Condous G, Forman A, Jansen FW, Bokor A, Simedrea V, Hudelist G. The #Enzian classification: a comprehensive non-invasive and surgical description system for endometriosis. Acta Obstet Gynecol Scand. 2021;100:1165–75. Nezhat C, Lindheim SR, Backhus L, Vu M, Vang N, Nezhat A, Nezhat C. Thoracic endometriosis syndrome: a review of diagnosis and management. JSLS. 2019;23:e2019.00029. Vigueras Smith A, Cabrera R, Kondo W, Ferreira H. Diaphragmatic endometriosis minimally invasive treatment: a feasible and effective approach. J Obstet Gynaecol. 2021;41:176–86. Vercellini P, Abbiati A, Vigano P, Somigliana ED, Daguati R, Meroni F, Crosignani PG. Asymmetry in distribution of diaphragmatic endometriotic lesions: evidence in favour of the menstrual reflux theory. Hum Reprod. 2007;22:2359–67. Kovarik JL, Toll GD. Thoracic endometriosis with recurrent spontaneous pneumothorax. JAMA. 1966;196:595–7. Hwang SM, Lee CW, Lee BS, Park JH. Clinical features of thoracic endometriosis: a single center analysis. Obstet Gynecol Sci. 2015;58:223–31. Joseph J, Sahn SA. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med. 1996;100:164–70. Bobbio A, Canny E, Mansuet Lupo A, Lococo F, Legras A, Magdeleinat P, Regnard JF, Gompel A, Damotte D, Alifano M. Thoracic endometriosis syndrome other than pneumothorax: clinical and pathological findings. Ann Thorac Surg. 2017;104:1865–71. Honore GM. Extrapelvic endometriosis. Clin Obstet Gynecol. 1999;42:699–711. Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: a review. Reprod Med Biol. 2020;19:323–33. Korom S, Canyurt H, Missbach A, Schneiter D, Kurrer MO, Haller U, Keller PJ, Furrer M, Weder W. Catamenial pneumothorax revisited: clinical approach and systematic review of the literature. J Thorac Cardiovasc Surg. 2004;128:502–8. Chamie LP, Blasbalg R, Pereira RM, Warmbrand G, Serafini PC. Findings of pelvic endometriosis at transvaginal US, MR imaging, and laparoscopy. Radiographics. 2011;31:E77–100. Velagapudi RK, Egan JP III. Thoracic endometriosis: a clinical review and update of current and evolving diagnostic and therapeutic techniques. Curr Pulmonol Rep. 2021;10:22–9. Kuo PH, Wang HC, Liaw YS, Kuo SH. Bronchoscopic and angiographic findings in tracheobronchial endometriosis. Thorax. 1996;51:1060–1. Sakamoto K, Ohmori T, Takei H. Catamenial pneumothorax caused by endometriosis in the visceral pleura. Ann Thorac Surg. 2003;76:290–1. Light RW, O’Hara VS, Moritz TE, McElhinney AJ, Butz R, Haakenson CM, Read RC, Sassoon CS, Eastridge CE, Berger R, et al. Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax. Results of a Department of Veterans Affairs Cooperative Study. JAMA. 1990;264:2224–30. Marchiori E, Zanetti G, Rodrigues RS, Souza LS, Souza Junior AS, Francisco FA, Hochhegger B. Pleural endometriosis: findings on magnetic resonance imaging. J Bras Pneumol. 2012;38:797–802. Rangunwala J, Sitta J, Vyas K, Roda M. Multimodality thoracoabdominal imaging findings in a rare case of thoracic endometriosis syndrome. Cureus. 2020;12:e6819. Lee YR, Choi YW, Jeon SC, Paik SS, Kang JH. On the AJR viewbox. Pleuropulmonary endometriosis: CT-pathologic correlation. AJR Am J Roentgenol. 2006;186:1800–1. Pallisa E, Sanz P, Roman A, Majo J, Andreu J, Caceres J. Lymphangioleiomyomatosis: pulmonary and abdominal findings with pathologic correlation. Radiographics. 2002;22:S185–98. Seaman DM, Meyer CA, Gilman MD, McCormack FX. Diffuse cystic lung disease at high-resolution CT. AJR Am J Roentgenol. 2011;196:1305–11. Pagano F, Schwander A, Vaineau C, Knabben L, Nirgianakis K, Imboden S, Mueller MD. True prevalence of diaphragmatic endometriosis and its association with severe endometriosis: a call for awareness and investigation. J Minim Invasive Gynecol. 2023;30:329–34. Naem A, Andrikos A, Constantin AS, Khamou M, Andrikos D, Lagana AS, De Wilde RL, Krentel H. Diaphragmatic endometriosis—a single-center retrospective analysis of the patients’ demographics, symptomatology, and long-term treatment outcomes. J Clin Med. 2023;12:6455. Rousset P, Gregory J, Rousset-Jablonski C, Hugon-Rodin J, Regnard JF, Chapron C, Coste J, Golfier F, Revel MP. MR diagnosis of diaphragmatic endometriosis. Eur Radiol. 2016;26:3968–77. Author information Authors and Affiliations Editor information Editors and Affiliations Rights and permissions Copyright information © 2025 The Author(s), under exclusive license to Springer Nature Switzerland AG About this chapter Cite this chapter Kido, A., Himoto, Y., Ojima, T., Tsuchiya, T. (2025). Thoracic and Diaphragmatic Endometriosis. In: Thomassin-Naggara, I. (eds) Imaging of Endometriosis: A Comparative Guide of US, MRI and Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-82750-1_12 Download citation DOI: https://doi.org/10.1007/978-3-031-82750-1_12 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-031-82749-5 Online ISBN: 978-3-031-82750-1 eBook Packages: MedicineMedicine (R0)