Two surgical cases of right thoracic endometriotic pneumothorax with adipose-like findings on diaphragm and lung

Akimu Sobue, Teruaki Mizobuchi, A. Nakagawa, Yuki Ito, Yuki Tada, Kaoru Nagato
In: The Journal of the Japanese Association for Chest Surgery · 2025 · vol. 39(2) , pp. 96–102 · doi:10.2995/jacsurg.39.96 · W4408506063
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Two surgical cases of thoracic endometriosis presenting as recurrent right pneumothorax showed adipose-like findings on the diaphragm and lung, suggesting the condition should be considered even with atypical diaphragmatic findings.

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Abstract

背景．胸腔内子宮内膜症性気胸では，横隔膜に血腫・裂孔・瘢痕型の典型的な所見を示すとされる．今回，横隔膜および肺に脂肪組織様所見を呈する胸腔内子宮内膜症性気胸の2手術例を経験した．症例1．30歳女性．他院で2回の右気胸の手術時に，ともに横隔膜に有意な所見を認めず．その後，月経期に右気胸を繰り返し，胸腔内子宮内膜症を考慮．3回目の手術でも横隔膜に典型的所見を認めなかったが，横隔膜腱中心に脂肪組織の集簇部位が有り，横隔膜部分切除の病理像から胸腔内子宮内膜症の診断となる．症例2．35歳女性．月経期の右気胸・胸痛から胸腔内子宮内膜症を疑う．手術で横隔膜腱中心に小脂肪結節と中葉肺S4葉間部に脂肪様組織を伴う肺気腫性変化あり，両部位を切除しともに病理学的に子宮内膜症所見を認めた．結論．月経時期に右気胸・胸痛を繰り返す症例では，横隔膜所見が非典型的でも胸腔内子宮内膜症性気胸の可能性を考慮すべきと考える．

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