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Keyes S, Spouge RJ, Kennedy P, Rai S, Abdellatif W, Sugrue G, Barrett SA, Khosa F, Nicolaou S, Murray N. Approach to Acute Traumatic and Nontraumatic Diaphragmatic Abnormalities. Radiographics 2024; 44:e230110. [PMID: 38781091 DOI: 10.1148/rg.230110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Acute diaphragmatic abnormalities encompass a broad variety of relatively uncommon and underdiagnosed pathologic conditions, which can be subdivided into nontraumatic and traumatic entities. Nontraumatic abnormalities range from congenital hernia to spontaneous rupture, endometriosis-related disease, infection, paralysis, eventration, and thoracoabdominal fistula. Traumatic abnormalities comprise both blunt and penetrating injuries. Given the role of the diaphragm as the primary inspiratory muscle and the boundary dividing the thoracic and abdominal cavities, compromise to its integrity can yield devastating consequences. Yet, diagnosis can prove challenging, as symptoms may be vague and findings subtle. Imaging plays an essential role in investigation. Radiography is commonly used in emergency evaluation of a patient with a suspected thoracoabdominal process and may reveal evidence of diaphragmatic compromise, such as abdominal contents herniated into the thoracic cavity. CT is often superior, in particular when evaluating a trauma patient, as it allows rapid and more detailed evaluation and localization of pathologic conditions. Additional modalities including US, MRI, and scintigraphy may be required, depending on the clinical context. Developing a strong understanding of the acute pathologic conditions affecting the diaphragm and their characteristic imaging findings aids in efficient and accurate diagnosis. Additionally, understanding the appearance of diaphragmatic anatomy at imaging helps in differentiating acute pathologic conditions from normal variations. Ultimately, this knowledge guides management, which depends on the underlying cause, location, and severity of the abnormality, as well as patient factors. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Sarah Keyes
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Rebecca J Spouge
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Padraic Kennedy
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Shamir Rai
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Waleed Abdellatif
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Gavin Sugrue
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Sarah A Barrett
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Faisal Khosa
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Savvas Nicolaou
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Nicolas Murray
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
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Bobbio A, Gherzi L, Tormen F, Sion A, Prieto M, Daffre E, Fournel L, Alifano M. A surgical series on endometriosis-related diaphragmatic hernia. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02016-y. [PMID: 38461451 DOI: 10.1007/s11748-024-02016-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Thoracic endometriosis syndrome gives rise to various clinical and radiological manifestations. We reviewed the records of patients operated for intrathoracic migration of abdominal viscera through a diaphragmatic hernia secondary to thoracic endometriosis. METHODS We retrospectively reviewed the single-center prospective collected database of all patients operated for thoracic endometriosis during the twenty years. All cases in which an abdominal organ was found to be herniated into the thoracic cavity were retrieved. Clinical and pathological data are presented and analyzed. RESULTS Twenty women of median age 36 (range 25-58) years were operated for endometriosis-related diaphragmatic hernia. The hernia was diagnosed concomitantly with endometriosis-related pneumothorax in 13 cases and during the exploration of catamenial thoracic pain in seven cases. There were 18 cases on the right side and two cases on the left side. The median diameter of the hernia was 8 cm (2.5-20 cm). In seventeen cases, the hernia was repaired by direct suture, and in three cases a heterologous prosthesis was positioned. At follow-up, two patients had an episode of recurrent pneumothorax. CONCLUSIONS Diaphragmatic hernia should be ruled out in the presence of endometriosis-related pneumothorax or catamenial thoracic pain. Surgery is indicated to make a pathological diagnosis, restore anatomy, and prevent recurrence in patients presenting with pneumothorax.
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Affiliation(s)
- Antonio Bobbio
- Service de Chirurgie Thoracique, Hôpitaux Universitaires Paris Centre, AP-HP 27, rue Faubourg Saint Jacques, 75014, Paris Cedex 14, France.
- Faculté de Médecine, Université Paris-Descartes, Paris, France.
| | - Lorenzo Gherzi
- Service de Chirurgie Thoracique, Hôpitaux Universitaires Paris Centre, AP-HP 27, rue Faubourg Saint Jacques, 75014, Paris Cedex 14, France
| | - Francesco Tormen
- Service de Chirurgie Thoracique, Hôpitaux Universitaires Paris Centre, AP-HP 27, rue Faubourg Saint Jacques, 75014, Paris Cedex 14, France
| | - Antoine Sion
- Service de Chirurgie Thoracique, Hôpitaux Universitaires Paris Centre, AP-HP 27, rue Faubourg Saint Jacques, 75014, Paris Cedex 14, France
| | - Mathilde Prieto
- Service de Chirurgie Thoracique, Hôpitaux Universitaires Paris Centre, AP-HP 27, rue Faubourg Saint Jacques, 75014, Paris Cedex 14, France
| | - Elisa Daffre
- Service de Chirurgie Thoracique, Hôpitaux Universitaires Paris Centre, AP-HP 27, rue Faubourg Saint Jacques, 75014, Paris Cedex 14, France
| | - Ludovic Fournel
- Service de Chirurgie Thoracique, Hôpitaux Universitaires Paris Centre, AP-HP 27, rue Faubourg Saint Jacques, 75014, Paris Cedex 14, France
- Faculté de Médecine, Université Paris-Descartes, Paris, France
| | - Marco Alifano
- Service de Chirurgie Thoracique, Hôpitaux Universitaires Paris Centre, AP-HP 27, rue Faubourg Saint Jacques, 75014, Paris Cedex 14, France
- Faculté de Médecine, Université Paris-Descartes, Paris, France
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Lv Q, Zhang Y, Yang R, Dai Y, Lin Y, Sun K, Xu H, Tao K. Photoacoustic Imaging Endometriosis Lesions with Nanoparticulate Polydopamine as a Contrast Agent. Adv Healthc Mater 2024; 13:e2302175. [PMID: 37742067 DOI: 10.1002/adhm.202302175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/21/2023] [Indexed: 09/25/2023]
Abstract
Endometriosis (EM) is a prevalent and debilitating gynecological disorder primarily affecting women of reproductive age. The diagnosis of EM is historically hampered by delays, owing to the absence of reliable diagnostic and monitoring techniques. Herein, it is reported that photoacoustic imaging can be a noninvasive modality for deep-seated EM by employing a hyaluronic-acid-modified polydopamine (PDA@HA) nanoparticle as the contrast agent. The PDA@HA nanoparticles exhibit inherent absorption and photothermal effects when exposed to near-infrared light, proficiently converting thermal energy into sound waves. Leveraging the targeting properties of HA, distinct photoacoustic signals emanating from the periphery of orthotopic EM lesions are observed. These findings are corroborated through anatomical observations and in vivo experiments involving mice with green fluorescent protein-labeled EM lesions. Moreover, the changes in photoacoustic intensity over a 24 h period reflect the dynamic evolution of PDA@HA nanoparticle biodistribution. Through the utilization of a photoacoustic ultrasound modality, in vivo assessments of EM lesion volumes are conducted. This innovative approach not only facilitates real-time monitoring of the therapeutic kinetics of candidate drugs but also obviates the need for the sacrifice of experimental mice. As such, this study presents a promising avenue for enhancing the diagnosis and drug-screening processes of EM.
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Affiliation(s)
- Quanjie Lv
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering Shanghai Jiao Tong University, Shanghai, 200240, P. R. China
| | - Yili Zhang
- International Peace Maternity and Child Health Hospital, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, P. R. China
| | - Ruihao Yang
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering Shanghai Jiao Tong University, Shanghai, 200240, P. R. China
| | - Yingfan Dai
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering Shanghai Jiao Tong University, Shanghai, 200240, P. R. China
| | - Yu Lin
- International Peace Maternity and Child Health Hospital, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, P. R. China
| | - Kang Sun
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering Shanghai Jiao Tong University, Shanghai, 200240, P. R. China
| | - Hong Xu
- International Peace Maternity and Child Health Hospital, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, P. R. China
| | - Ke Tao
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering Shanghai Jiao Tong University, Shanghai, 200240, P. R. China
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4
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Naylor A, Raptis DA, Bhalla S. Focal Pleural Lesions. Semin Roentgenol 2023; 58:411-419. [PMID: 37973270 DOI: 10.1053/j.ro.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/02/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Adam Naylor
- Clinical Fellow, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Demetrios A Raptis
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO.
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5
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Nezhat C, Armani E, Chen HCC, Najmi Z, Lindheim SR, Nezhat C. Use of the Free Endometriosis Risk Advisor App as a Non-Invasive Screening Test for Endometriosis in Patients with Chronic Pelvic Pain and/or Unexplained Infertility. J Clin Med 2023; 12:5234. [PMID: 37629276 PMCID: PMC10455338 DOI: 10.3390/jcm12165234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Endometriosis is a prevalent condition that affects millions of individuals globally, leading to various symptoms and significant disruptions to their quality of life. However, the diagnosis of endometriosis often encounters delays, emphasizing the pressing need for non-invasive screening. This retrospective cross-sectional study aimed to evaluate the utility of the Endometriosis Risk Advisor (EndoRA) mobile application in screening for endometriosis in patients with chronic pelvic pain and/or unexplained infertility. The study consisted of 293 patients who met specific criteria: they were English-speaking individuals with chronic pelvic pain and/or unexplained infertility, owned smartphones, and had no prior diagnosis of endometriosis. The results demonstrated that the EndoRA score exhibited a high sensitivity of 93.1% but a low specificity of 5.9% in detecting endometriosis. The positive predictive value was 94.1%, while the negative predictive value was 5.0%. Although the study had limitations and potential selection bias, its findings suggest that EndoRA can serve as a valuable screening tool for high-risk individuals, enabling them to identify themselves as being at an increased risk for endometriosis. EndoRA's non-invasive nature, free access, and easy accessibility have the potential to streamline evaluation and treatment processes, thereby empowering individuals to seek timely care and ultimately improving patient outcomes and overall well-being.
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Affiliation(s)
- Camran Nezhat
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
- Stanford University Medical Center, Palo Alto, CA 94305, USA
- University of California San Francisco, San Francisco, CA 94143, USA
| | - Ellie Armani
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
| | - Hsuan-Chih Carolina Chen
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
- Stanford University Medical Center, Palo Alto, CA 94305, USA
| | - Zahra Najmi
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
| | - Steven R. Lindheim
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45324, USA
- Department of Obstetrics and Gynecology, University of Central Florida, Orlando, FL 32827, USA
- Center for Reproductive Medicine Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Ceana Nezhat
- Nezhat Medical Center, Atlanta Center for Special Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA 30342, USA
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Maciel C, Ferreira H, Djokovic D, Kyaw Tun J, Keckstein J, Rizzo S, Manganaro L. MRI of endometriosis in correlation with the #Enzian classification: applicability and structured report. Insights Imaging 2023; 14:120. [PMID: 37405519 DOI: 10.1186/s13244-023-01466-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023] Open
Abstract
Endometriosis represents one of the most common causes of life-impacting chronic pelvic pain and female infertility. Magnetic resonance imaging (MRI) plays an increasing role in the diagnosis and mapping of endometriosis, while diagnostic laparoscopy currently tends to be reserved for the patients with negative imaging results. The #Enzian, published in 2021, proposes a new comprehensive classification system of endometriosis, combining a complete staging of deep infiltrative endometriosis with the evaluation of peritoneal/ovarian/tubal localizations and the presence of adenomyosis. This article addresses in detail the applicability of the #Enzian classification, primarily based on surgical findings, to the MRI evaluation of the endometriosis. Overall, there is a significant matching between MRI features and the #Enzian classification criteria, two different perspectives of endometriosis mapping, with different goals and levels of detail. The main discrepancy lies in the evaluation of tubo-ovarian condition, which is not fully assessable by MRI. Furthermore, as endometriosis is a complex disease, usually multifocal, that can present with a myriad of imaging findings, MRI reporting should be clear and well organized. The authors group, both radiologists and gynecologists, propose a structured MRI report of endometriosis in correlation with the #Enzian classification, merging the detailed anatomical and pre-operative information provided by the MRI with the benefits of a comprehensive classification system of endometriosis in the clinical practice and research field.Critical relevance statement This article addresses in detail the applicability of the #Enzian classification, primarily based on surgical findings, to the MRI evaluation of the endometriosis and proposes a #Enzian-based structured MRI report.
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Affiliation(s)
- Cristina Maciel
- Serviço de Radiologia, Centro Hospitalar Universitário São João, Porto, Portugal.
- Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Hélder Ferreira
- Serviço de Ginecologia, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
| | - Dusan Djokovic
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal
- Department of Obstetrics and Gynecology, NOVA Medical School - Faculdade de Ciências Médicas, NOVA University of Lisbon, Lisbon, Portugal
- Department of Obstetrics and Gynecology, Hospital CUF Descobertas, Lisbon, Portugal
| | - Jimmy Kyaw Tun
- Department of Interventional Radiology, The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
| | - Jörg Keckstein
- Scientific Endometriosis Foundation (Stiftung Endometrioseforschung/SEF), Westerstede, Germany
- Endometriosis Clinic Dres. Keckstein, Villach, Austria
- University of Ulm, Ulm, Germany
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via G. Buffi 13, 6900, Lugano, Switzerland
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
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Borgheresi A, Agostini A, Pierpaoli L, Bruno A, Valeri T, Danti G, Bicci E, Gabelloni M, De Muzio F, Brunese MC, Bruno F, Palumbo P, Fusco R, Granata V, Gandolfo N, Miele V, Barile A, Giovagnoni A. Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach. Tomography 2023; 9:1153-1186. [PMID: 37368547 DOI: 10.3390/tomography9030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The approach to thoracic imaging may be challenging for the beginner due to the wide spectrum of diseases, their overlap, and the complexity of radiological findings. The first step consists of the proper assessment of the basic imaging findings. This review is divided into three main districts (mediastinum, pleura, focal and diffuse diseases of the lung parenchyma): the main findings will be discussed in a clinical scenario. Radiological tips and tricks, and relative clinical background, will be provided to orient the beginner toward the differential diagnoses of the main thoracic diseases.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Luca Pierpaoli
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Alessandra Bruno
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Tommaso Valeri
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Eleonora Bicci
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
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8
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Quercia R, De Palma A, De Blasi F, Carleo G, De Iaco G, Panza T, Garofalo G, Simone V, Costantino M, Marulli G. Catamenial pneumothorax: Not only VATS diagnosis. Front Surg 2023; 10:1156465. [PMID: 37082366 PMCID: PMC10110870 DOI: 10.3389/fsurg.2023.1156465] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/07/2023] [Indexed: 04/22/2023] Open
Abstract
Background Catamenial pneumothorax (CP) is a rare type of spontaneous, recurring pneumothorax occurring in women, from the day before menstruation until 72 hours after its beginning. Conservative treatment is generally associated with recurrence of CP. Video-assisted thoracic surgery (VATS) approach allows not only to obtain diagnosis but also to guide definitive treatment of causing lesions, such as ectopic endometrial implants or diaphragmatic defects and fenestrations. We report our experience in VATS management of CP to focus on its role in CP. Materials and methods In this retrospective observational study, we collected data from women referred to our center for CP, from January 2019 to April 2022. All patients underwent VATS approach, with muscle-sparing thoracotomy when diaphragmatic fenestrations were detected, to perform selective diaphragmatic plication and/or partial diaphragmatic resection. Results were analyzed in terms of pneumothorax recurrence after surgical treatment. All patients were referred to gynecologists for medical therapy. Results Eight women (median age 36 years, range: 21-45), all with right side CP, were included; three already had pelvic endometriosis and two had already undergone lung apicectomy at other institutions. VATS allowed us to detect diaphragmatic fenestrations in seven patients (87.5%) and apical bullae in five (62.5%). Apicectomy was performed in five cases (62.5%), selective diaphragmatic plication in two (25%), and partial diaphragmatic resection in five (62.5%). Chemical pleurodesis with talc was performed in all to minimize the risk of recurrence. Pathological diagnosis of endometriosis on the resected diaphragm was achieved in five patients (62.5%). No recurrence occurred, except for one woman who stopped medical treatment for endometriosis. Conclusions In the management of patients with CP, VATS should be recommended not only to obtain an explorative diagnosis of ectopic endometrial implants or diaphragmatic fenestrations but also to allow the most appropriate surgical treatment and obtain pathological specimens for confirmation and definitive diagnosis of thoracic endometriosis. Medical therapy to achieve ovarian rest is mandatory in the postoperative period and should not be discontinued.
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9
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Thoracic and diaphragmatic endometriosis: an overview of diagnosis and surgical treatment. Curr Opin Obstet Gynecol 2022; 34:204-209. [PMID: 35895962 DOI: 10.1097/gco.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Thoracic endometriosis is a rare disease that can lead to a variety of clinical manifestations. There are currently no guidelines for optimal diagnosis and management of the disease. The purpose of this review is to provide an overview of the diagnosis and surgical treatment of thoracic endometriosis. RECENT FINDINGS Various imaging modalities, including computed tomography (CT), MRI and ultrasound, have been reported in the detection of thoracic endometriosis. MRI is the most sensitive imaging study and may aid in preoperative planning. Histopathology of a biopsied lesion remains the gold standard for diagnosis. Surgical management of thoracic endometriosis may involve laparoscopy and/or thoracoscopy, and surgical planning should include preparation for single ventilation capability. A multidisciplinary approach involving a gynaecologic surgeon and thoracic surgeon may be considered. Repairing diaphragm defects and pleurodesis are shown to decrease recurrent symptoms. SUMMARY Although optimal diagnostic testing remains uncertain, a high clinical suspicion for thoracic endometriosis is critical to ensure prompt diagnosis and treatment in order to prevent recurrent symptoms and progression to more serious sequalae. Minimally invasive surgical techniques are becoming increasingly utilized and allow for thorough evaluation and treatment of thoracic endometriosis.
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10
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Svidinskaya EA, Lysenko AV, Brykin GV. [Mystery of endometriosis - catamenial pneumothorax]. Khirurgiia (Mosk) 2022:110-116. [PMID: 35477211 DOI: 10.17116/hirurgia2022041110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review is devoted to clinical picture, main theories of pathogenesis, traditional and innovative methods of diagnosis and surgical treatment of catamenial pneumothorax. Currently, clinicians prefer magnetic resonance imaging and thoracoscopy for diagnosis of this disease. Various researchers are actively searching for laboratory diagnostic methods that can confirm endometrioid nature of pneumothorax. Treatment and prevention of catamenial pneumothorax are a controversial issue depending both clinical picture and preferences of the attending physician. Currently, the majority of authors believe that hormonal therapy combined with diaphragm resection ensures optimal anti-relapse effect in patients with thoracic endometriosis.
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Affiliation(s)
- E A Svidinskaya
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Lysenko
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - G V Brykin
- Sechenov First Moscow State Medical University, Moscow, Russia
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11
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Ouede R, Kone Z, Kohou-Kone L, Kouacou M, Okon G, Demine B, N’guessan E, Kendja K, Tanauh Y. Hémothorax cataménial : résultats de 11 cas opérés. Rev Mal Respir 2022; 39:221-227. [DOI: 10.1016/j.rmr.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 12/30/2021] [Indexed: 11/24/2022]
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12
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Kalbi DP, Al Sbihi AF, Manasrah N, Chaudhary AJ, Iqbal S. A Thoracic Endometriosis-Related Catamenial Hemopneumothorax in a Woman With Premature Ovarian Failure. Cureus 2021; 13:e17110. [PMID: 34532165 PMCID: PMC8436833 DOI: 10.7759/cureus.17110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/05/2022] Open
Abstract
Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. It is usually confined to the pelvis, particularly the ovaries, cul-de-sac, broad ligaments, and uterosacral ligaments, but it can also expand outside the pelvis. The thorax is among the common extrapelvic locations. Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of functioning endometrial tissue in the pleura, lung parenchyma, and airways. This report presents a case of a young female patient with advanced endometriosis and premature ovarian failure who was admitted with dyspnea that turned to be due to a rare endometriosis-related complication.
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Affiliation(s)
- Deepak P Kalbi
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA.,Nuclear Medicine, Montefiore Medical Center, New York, USA
| | - Ali F Al Sbihi
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
| | - Nouraldeen Manasrah
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
| | - Ahmed J Chaudhary
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
| | - Sana Iqbal
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
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13
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Singh M, Singh RB, Singh AB, Carballo AL, Jain A. Thoracic Endometriosis: Still a Diagnostic Dilemma. Cureus 2021; 13:e15610. [PMID: 34131552 PMCID: PMC8196491 DOI: 10.7759/cureus.15610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2021] [Indexed: 11/15/2022] Open
Abstract
We report a case of thoracic endometriosis syndrome (TES) presenting with a five-week history of progressive shortness of breath, cough, and wheezing. Investigations revealed a large, right-sided pleural effusion that was bloody on aspiration. A diagnosis of TES was one of the diagnoses entertained and eventually confirmed on finding evidence of pelvic endometriosis on laparotomy. The management of TES should include hormonal therapy, surgical management, or a combination of both.
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Affiliation(s)
- Madhu Singh
- Obstetrics and Gynecology, Dr. Balwant Singh's Hospital Inc, Georgetown, GUY
| | - Rahul B Singh
- Accident and Emergency, Dr. Balwant Singh's Hospital Inc, Georgetown, GUY
| | - Abhishek B Singh
- Obstetrics and Gynecology, Dr. Balwant Singh's Hospital Inc, Georgetown, GUY
| | - Aziel L Carballo
- Internal Medicine, Dr. Balwant Singh's Hospital Inc, Georgetown, GUY
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14
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Wetzel A, Philip CA, Golfier F, Bonnot PE, Cotte E, Brichon PY, Darnis B, Chene G, Michy T, Hoffmann P, Tronc F, Dubernard G. Surgical management of diaphragmatic and thoracic endometriosis': A French multicentric descriptive study. J Gynecol Obstet Hum Reprod 2021; 50:102147. [PMID: 33862264 DOI: 10.1016/j.jogoh.2021.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Surgical management of Diaphragmatic and thoracic endometriosis (DTE) is still controversial, a thoracic or an abdominal approach can be proposed. METHODS We conducted a multicentric retrospective study in 8 thoracic, gynecology or digestive surgery units in 5 French university hospitals. The main objective was to review the current management of DTE. RESULTS 50 patients operated for DTE from 2010 to 2017 were included: 26 with a thoracic approach and 24 with an abdominal approach. Preoperative pelvic endometriosis (PE) concerned 25 patients. In 38 patients, DTE diagnosis was made on clinical symptoms (pneumothorax (n = 19), chronic or catamenial chest pain (n = 18) or hemopneumothorax (n = 1)). Median time from onset of symptoms to diagnosis was 47 months (0-212). PE surgery concurrently occurred in 22 patients. We report diaphragmatic nodules, pleuropulmonary nodules and diaphragmatic perforations in 42, 5 and 22 women respectively. Lesions were right-sided in 45 patients. Nodules were destructed in 12 cases and resected in 38 cases. When a diaphragmatic reconstruction was needed (n = 31), a simple suture was performed in 26 patients, while 5 patients needed a mesh repair. Pleural symphysis was performed for all patients who received a thoracic approach. DTE resection was considered complete in 46 patients. Three patients had severe 30-days complications of DTE surgery. Median follow-up was 20 months (range 1-69). Recurrence occurred in 10 patients. CONCLUSION The results emphasize the importance of systematically looking for chest pain in patients suffering from PE and underline the lack of a standardized procedure and treatment in DTE.
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Affiliation(s)
- Alexia Wetzel
- Department of gynecology, Croix Rousse University Hospital, Hospices civils de Lyon (HCL), 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.
| | - Charles-André Philip
- Department of gynecology, Croix Rousse University Hospital, Hospices civils de Lyon (HCL), 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.
| | - Francois Golfier
- Department of gynecology, Lyon-Sud university hospital, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France.
| | - Pierre-Emmanuel Bonnot
- Department of digestive surgery, Lyon- Sud university hospital, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France.
| | - Eddy Cotte
- Department of digestive surgery, Lyon- Sud university hospital, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France.
| | - Pierre-Yves Brichon
- Department of thoracic surgery, Grenoble University hospital, Avenue Maquis du Grésivaudan, 38700 La Tronche, France.
| | - Benjamin Darnis
- Department of digestive surgery, Croix Rousse University Hospital, HCL, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.
| | - Gautier Chene
- Department of gynecology, Hopital Femme Mère Enfant, HCL, 59 Boulevard Pinel, 69500 Bron, France.
| | - Thierry Michy
- Department of gynecology, Grenoble University hospital, Avenue Maquis du Grésivaudan, 38700 La Tronche, France.
| | - Pascale Hoffmann
- Department of gynecology, Grenoble University hospital, Avenue Maquis du Grésivaudan, 38700 La Tronche, France.
| | - Francois Tronc
- Department of thoracic surgery, Louis Pradel University Hospital HCL, 59 Boulevard Pinel, 69500 Bron, France.
| | - Gil Dubernard
- Department of gynecology, Croix Rousse University Hospital, Hospices civils de Lyon (HCL), 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.
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15
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Nguyen ET, Bayanati H, Bilawich AM, Sanchez Tijmes F, Lim R, Harris S, Dennie C, Oikonomou A. Canadian Society of Thoracic Radiology/Canadian Association of Radiologists Clinical Practice Guidance for Non-Vascular Thoracic MRI. Can Assoc Radiol J 2021; 72:831-845. [PMID: 33781127 DOI: 10.1177/0846537121998961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Historically thoracic MRI has been limited by the lower proton density of lung parenchyma, cardiac and respiratory motion artifacts and long acquisition times. Recent technological advancements in MR hardware systems and improvement in MR pulse sequences have helped overcome these limitations and expand clinical opportunities for non-vascular thoracic MRI. Non-vascular thoracic MRI has been established as a problem-solving imaging modality for characterization of thymic, mediastinal, pleural chest wall and superior sulcus tumors and for detection of endometriosis. It is increasingly recognized as a powerful imaging tool for detection and characterization of lung nodules and for assessment of lung cancer staging. The lack of ionizing radiation makes thoracic MRI an invaluable imaging modality for young patients, pregnancy and for frequent serial follow-up imaging. Lack of familiarity and exposure to non-vascular thoracic MRI and lack of consistency in existing MRI protocols have called for clinical practice guidance. The purpose of this guide, which was developed by the Canadian Society of Thoracic Radiology and endorsed by the Canadian Association of Radiologists, is to familiarize radiologists, other interested clinicians and MR technologists with common and less common clinical indications for non-vascular thoracic MRI, discuss the fundamental imaging findings and focus on basic and more advanced MRI sequences tailored to specific clinical questions.
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Affiliation(s)
- Elsie T Nguyen
- Cardiothoracic Division, Joint Department of Medical Imaging, 33540Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hamid Bayanati
- Thoracic Division, Department of Medical Imaging, The Ottawa Hospital, 12365University of Ottawa, Ottawa, Ontario, Canada
| | - Ana-Maria Bilawich
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Felipe Sanchez Tijmes
- Joint Department of Medical Imaging, Toronto General Hospital, 7938University of Toronto, Toronto, Ontario, Canada
| | - Robert Lim
- Thoracic Division, Department of Medical Imaging, The Ottawa Hospital, 12365University of Ottawa, Ottawa, Ontario, Canada
| | - Scott Harris
- 7512Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Carole Dennie
- Department of Medical Imaging, The Ottawa Hospital, 7938University of Ottawa, Ottawa, Ontario, Canada.,Cardiac Radiology and MRI, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,27337The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anastasia Oikonomou
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, 7938University of Toronto, Toronto, Ontario, Canada
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16
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Verhulst E, Bafort C, Tomassetti C, Wolthuis A, Bielen D, Coolen J, Weynand B, Platteeuw L, Meuleman C, Van Raemdonck D. Endometriotic lung cyst causing catamenial hemoptysis; a case report and review of literature. Acta Chir Belg 2021; 122:432-437. [PMID: 33657969 DOI: 10.1080/00015458.2021.1887556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report a rare case of an endometriotic lung cyst in a 47-year woman with recurrent catamenial hemoptysis. Chest computed tomography (CT) obtained outside the menstruation in October 2019 revealed a cystic lesion (2.5 cm) located in the right inferior lobe near the distal esophagus and the inferior pulmonary vein. Compared to CT abdomen in May 2019, this lesion had increased with a larger volume and a thicker wall. An endometrial lung cyst was suspected as episodes of hemoptysis no longer occurred after initiating hormonal treatment with nomegestrol acetate. Exploratory video-assisted thoracoscopic surgery with wedge resection of the cyst was performed. Histopathologic examination confirmed the diagnosis of an endometriotic cystic lesion. Postoperative course was uneventful with no further symptoms since then.
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Affiliation(s)
- Evelyne Verhulst
- Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
| | - Celine Bafort
- Doctoral School, Biomedical Sciences, Catholic University Leuven, Leuven, Belgium
| | - Carla Tomassetti
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Didier Bielen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Johan Coolen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Birgit Weynand
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | | | - Christel Meuleman
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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17
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Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet 2021; 397:839-852. [PMID: 33640070 DOI: 10.1016/s0140-6736(21)00389-5] [Citation(s) in RCA: 360] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/09/2020] [Accepted: 08/14/2020] [Indexed: 12/14/2022]
Abstract
Endometriosis is a common disease affecting 5-10% of women of reproductive age globally. However, despite its prevalence, diagnosis is typically delayed by years, misdiagnosis is common, and delivery of effective therapy is prolonged. Identification and prompt treatment of endometriosis are essential and facilitated by accurate clinical diagnosis. Endometriosis is classically defined as a chronic, gynaecological disease characterised by endometrial-like tissue present outside of the uterus and is thought to arise by retrograde menstruation. However, this description is outdated and no longer reflects the true scope and manifestations of the disease. The clinical presentation is varied, the presence of pelvic lesions is heterogeneous, and the manifestations of the disease outside of the female reproductive tract remain poorly understood. Endometriosis is now considered a systemic disease rather than a disease predominantly affecting the pelvis. Endometriosis affects metabolism in liver and adipose tissue, leads to systemic inflammation, and alters gene expression in the brain that causes pain sensitisation and mood disorders. The full effect of the disease is not fully recognised and goes far beyond the pelvis. Recognition of the full scope of the disease will facilitate clinical diagnosis and allow for more comprehensive treatment than currently available. Progestins and low-dose oral contraceptives are unsuccessful in a third of symptomatic women globally, probably as a result of progesterone resistance. Oral gonadotropin-releasing hormone (GnRH) antagonists constitute an effective and tolerable therapeutic alternative when first-line medications do not work. The development of GnRH antagonists has resulted in oral drugs that have fewer side-effects than other therapies and has allowed for rapid movement between treatments to optimise and personalise endometriosis care. In this Review, we discuss the latest understanding of endometriosis as a systemic disease with multiple manifestations outside the parameters of classic gynaecological disease.
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Affiliation(s)
- Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
| | - Alexander M Kotlyar
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Valerie A Flores
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
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18
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Dhamrah U, Solomon N, Osuoji OC. An Unexpected Case of Malignant Mesothelioma in a Young Woman. J Investig Med High Impact Case Rep 2021; 9:2324709621997245. [PMID: 33629595 PMCID: PMC7926051 DOI: 10.1177/2324709621997245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 41-year-old female with a past medical history significant only for right retinal vein occlusion presented with chest pain, cough, and shortness of breath. After being found to have a large right-sided pleural effusion and undergoing a nondiagnostic thoracentesis, a noncontrast chest computed tomography scan revealed multiple diffuse nodules in the right lung with irregular paraspinal pleural thickening. An extensive workup followed, with computed tomography–guided biopsy ultimately revealing the diagnosis. The following report describes the patient presentation, laboratory findings, and extensive clinical investigation, and provides a discussion of the epidemiology, imaging findings, prognosis, and differential diagnoses for the illness in question.
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Affiliation(s)
- Umaima Dhamrah
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA
| | | | - Olive C Osuoji
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA
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19
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Soares T, Oliveira MA, Panisset K, Habib N, Rahman S, Klebanoff JS, Moawad GN. Diaphragmatic endometriosis and thoracic endometriosis syndrome: a review on diagnosis and treatment. Horm Mol Biol Clin Investig 2021; 43:137-143. [PMID: 34704688 DOI: 10.1515/hmbci-2020-0066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/03/2021] [Indexed: 11/15/2022]
Abstract
Endometriosis of the diaphragm has been gaining more attention in the practice of gynecologists and thoracic surgeons in recent years. Understanding related symptoms and developing imaging methods have improved their approach. A review of the literature was performed with the aim to report on incidence, diagnosis, treatment and prognosis of diaphragmatic endometriosis. We also cover the issue of the Thoracic Endometriosis Syndrome (TES). Complaints of cyclic chest pain in patients of childbearing age should have as differential diagnosis the presence of thoracic endometriosis. Catamenial pneumothorax is the main manifestation of diaphragmatic endometriosis and Thoracic Endometriosis Syndrome. Other possible manifestations are hemothorax, pulmonary nodules, and diaphragmatic hernia. Despite the possibility of drug treatment, many patients will be submitted to surgical treatment. The minimally invasive approach should be the one of choice. The robotic pathway allows for an easier approach due to its ability to articulate robotic arms, allowing the treatment of lesions in hard-to-reach locations, such as the posterior part of the diaphragm. Multidisciplinary treatment should be used in most cases, as only abdominal approach is not sufficient for the diagnosis and treatment of lesions in the thoracic cavity. The approach of endometriosis of the diaphragm and Thoracic Endometriosis Syndrome should be multidisciplinary, allowing the improvement of quality of life in most patients.
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Affiliation(s)
- Thiers Soares
- Department of Obstetrics and Gynecology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Cardoso Fontes Hospital, Gynecologic Section, Rio de Janeiro, Brazil.,Perinatal Hospital, Rio de Janeiro, Brazil.,Casa de Saúde São José, Rio de Janeiro, Brazil
| | - Marco Aurelio Oliveira
- Department of Obstetrics and Gynecology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Karen Panisset
- Perinatal Hospital, Rio de Janeiro, Brazil.,Maternal and Child Department, Fluminense Federal University, Niteroi, Brazil
| | - Nassir Habib
- Department of Obstetrics and Gynecology, Beaujon Hospital-University of Paris, Clichy Cedex, France
| | - Sara Rahman
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA
| | - Jordan S Klebanoff
- Department of Obstetrics and Gynecology, Main Line Health, Wynnewood, PA, USA
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA
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20
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Velagapudi RK, Egan JP. Thoracic Endometriosis: a Clinical Review and Update of Current and Evolving Diagnostic and Therapeutic Techniques. CURRENT PULMONOLOGY REPORTS 2021. [DOI: 10.1007/s13665-021-00269-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Purpose of Review
The goal of this review is to provide a comprehensive understanding of the pathophysiology, clinical presentation, diagnostic workup, and clinical management of thoracic endometriosis (TE), as well as highlight our personal experience with TE workup and management.
Recent Findings
TE can present in a wide range of clinical manifestations. Without high clinical suspicion, diagnosis can be delayed. Since no specific laboratory testing is available, diagnosis is often based on careful history taking, imaging, and direct visualization of endometrial lesions through video-assisted thoracoscopic surgery (VATS). Medical thoracoscopy (MT) may also be a useful tool in the diagnostic workup of TE.
Summary
The diagnosis and management of TE require a multidisciplinary approach and a high index of clinical suspicion. While VATS remains the gold standard for diagnosis, we share our experience using MT to diagnose and manage a case of TE-related hemothorax.
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21
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Patrucco Reyes S, Amoah K, Rahi MS, Gunasekaran K. A Case of Hemothorax as Manifestation of Thoracic Endometrial Syndrome. J Investig Med High Impact Case Rep 2021; 9:23247096211052191. [PMID: 34866438 PMCID: PMC8652914 DOI: 10.1177/23247096211052191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
Thoracic endometriosis is a rare progression of a mostly benign disease of ectopic endometrial activity involving the pleura and lung. This is a case of a young female who presented with progressive shortness of breath and was found to have significant anemia. Further investigations showed a massive right-sided pleural effusion and ascites. Subsequent thoracentesis and pelvic diagnostic laparoscopy showed a hemorrhagic pleural effusion and ascites, along with dense pelvic adhesions. Pathology was consistent with endometriosis. Patient improved on leuprolide acetate and norethindrone. This case illustrates an important consideration in the differential of a reproductive-age female with new onset shortness of breath and anemia.
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22
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Aboujaoude N, Iskandar M, Tannouri F. Catamenial hemoptysis: A case report of pulmonary endometriosis. Eur J Radiol Open 2020; 8:100302. [PMID: 33335954 PMCID: PMC7734216 DOI: 10.1016/j.ejro.2020.100302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 11/05/2022] Open
Abstract
We report a case of a patient diagnosed with pulmonary endometriosis and successfully treated with a GnRH agonist. This 34-year-old mother presented cyclic hemoptysis since 4-month. A non-enhanced computed tomography made at the end of the luteal phase revealed a solitary lung nodule with no other abnormalities. A contrast enhanced computed tomography conducted during menses revealed a ground glass opacity extending from the nodule towards hilum. The diagnosis of pulmonary endometriosis was established taking into account the clinical presentation and the imaging findings. Medical treatment by Triptorelin pamoate (Decapeptyl LP® 3 mg Ipsen Pharma, France), a GnRH agonist, was proposed for a period of 6 months. A CT scan performed 3 months after the end of the treatment shows a complete disappearance of the endometriosis nodular lesion.
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Affiliation(s)
- Nour Aboujaoude
- Department of Radiology, Notre Dame des Secours CHU, Byblos, Lebanon
| | - Maria Iskandar
- Department of Radiology, Notre Dame des Secours CHU, Byblos, Lebanon
| | - Fadi Tannouri
- Department of Radiology, Hospital Erasme, Brussels, Belgium
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Ciriaco P, Muriana P, Lembo R, Carretta A, Negri G. Treatment of Thoracic Endometriosis Syndrome: A Meta-Analysis and Review. Ann Thorac Surg 2020; 113:324-336. [PMID: 33345783 DOI: 10.1016/j.athoracsur.2020.09.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/11/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of functional endometrial tissue within the chest cavity. Up to 80% of women with TES present with concomitant pelvic endometriosis. The diagnostic-curative path is defined by both thoracic surgeons and gynecologists, consistent with the manifestation of the disease. The aim of the study was to analyze the different approaches to generate an ideal diagnosis-treatment algorithm that can be shared by both specialties. METHODS We searched PubMed and Scopus for studies that were completed by March 2019 and that included at least 8 patients with TES. Information on preoperative exams, surgical technique, postoperative management, and recurrence of disease was collected for meta-analysis. RESULTS Twenty-five studies including a total of 732 patients were eligible. Almost all of the patients underwent radiologic pelvis investigation (96%; confidence interval [CI], 87%-100%). Videothoracoscopy was the preferred surgical technique (84%; 95% CI, 66%-96%). Intraoperative evaluation revealed the presence of diaphragmatic anomalies in 84% of cases (95% CI, 73%-93%). The overall pooled prevalence of concomitant or staged laparoscopy was 52% (95% CI, 18%-85%). Postoperative hormone therapy was heterogeneous with a pooled prevalence of 61% (95% CI, 33%-86%; I2 = 95.6%; P < .01). Recurrence of symptoms was documented in 27% of patients (95% CI, 20%-34%; I2 = 54.7%; P < .01). CONCLUSIONS TES should be managed jointly by thoracic surgeons and gynecologists. Chest-abdomen magnetic resonance imaging seems to offer the most details for TES. Combined or staged videothoracoscopy and laparoscopy can provide adequate information to fine-tune proper surgical treatment and postoperative medical therapy.
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Affiliation(s)
- Paola Ciriaco
- Department of Thoracic Surgery, Scientific Institute and University Vita-Salute Ospedale San Raffaele, Milan, Italy.
| | - Piergiorgio Muriana
- Department of Thoracic Surgery, Scientific Institute and University Vita-Salute Ospedale San Raffaele, Milan, Italy
| | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, Scientific Institute and University Vita-Salute Ospedale San Raffaele, Milan, Italy
| | - Angelo Carretta
- Department of Thoracic Surgery, Scientific Institute and University Vita-Salute Ospedale San Raffaele, Milan, Italy
| | - Giampiero Negri
- Department of Thoracic Surgery, Scientific Institute and University Vita-Salute Ospedale San Raffaele, Milan, Italy
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24
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Bonnin A, Durot C, Djelouah M, Dohan A, Arrivé L, Rousset P, Hoeffel C. MR Imaging of the Perihepatic Space. Korean J Radiol 2020; 22:547-558. [PMID: 33236541 PMCID: PMC8005346 DOI: 10.3348/kjr.2019.0774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/02/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022] Open
Abstract
The perihepatic space is frequently involved in a spectrum of diseases, including intrahepatic lesions extending to the liver capsule and disease conditions involving adjacent organs extending to the perihepatic space or spreading thanks to the communication from intraperitoneal or extraperitoneal sites through the hepatic ligaments. Lesions resulting from the dissemination of peritoneal processes may also affect the perihepatic space. Here we discuss how to assess the perihepatic origin of a lesion and describe the magnetic resonance imaging (MRI) features of normal structures and fluids that may be abnormally located in the perihepatic space. We then review and illustrate the MRI findings present in cases of perihepatic infectious, tumor-related, and miscellaneous conditions. Finally, we highlight the value of MRI over computed tomography.
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Affiliation(s)
- Angèle Bonnin
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims, France.
| | - Carole Durot
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims, France
| | - Manel Djelouah
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims, France
| | - Anthony Dohan
- Department of Abdominal and Interventional Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, APHP, Paris, France.,Paris Descartes University, Sorbonne Paris-Cité-Paris V, Paris, France
| | - Lionel Arrivé
- Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Pascal Rousset
- Department of Radiology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France.,Lyon 1 Claude Bernard University, Lyon, France
| | - Christine Hoeffel
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims, France.,CRESTIC, Reims Champagne-Ardenne University, Reims, France
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25
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Yamamoto T, Fujikawa R, Arai Y, Nakamura T. Narrow band imaging for thoracic endometriosis. Surg Case Rep 2020; 6:242. [PMID: 32997223 PMCID: PMC7527378 DOI: 10.1186/s40792-020-01000-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 09/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background The thoracic cavity is the most frequent site of extrapelvic endometriosis. It exhibits a wide variety of clinical manifestations, such as chest pain, cough, and respiratory distress, and is frequently associated with pelvic endometriosis. Although histological confirmation is the gold standard for a definitive diagnosis, endoscopic identification of the affected area is often difficult. Narrow band imaging (NBI) is an imaging technique that emphasizes vascular structures and is reported to be useful in the diagnosis of pelvic endometriosis. Case presentations A 31-year-old woman and 39-year-old woman developed a recurrent right pneumothorax during their menstruation cycles. They both had no medical history suggesting pelvic endometriosis. We planned an elective video-assisted thoracoscopic surgery for the suspicion of thoracic endometriosis. In addition to white light alone, an NBI observation enhanced the microvasculature of the suspected lesions and allowed us to identify the affected area more clearly. Partial resections of the diaphragm were performed. Histopathological and immunohistochemical studies of each specimen confirmed the diagnosis of extrapelvic endometriosis. Conclusions NBI may improve the diagnostic accuracy for thoracic endometriosis, especially in clinically suspected patients but without a history of pelvic endometriosis.
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Affiliation(s)
- Takehiro Yamamoto
- Departments of General Thoracic Surgery and Pathology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan.
| | - Ryo Fujikawa
- Departments of General Thoracic Surgery and Pathology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Yoshifumi Arai
- Departments of General Thoracic Surgery and Pathology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Toru Nakamura
- Departments of General Thoracic Surgery and Pathology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan
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26
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Barzilai M, Roriz M, Guyard A, Debray MP, Pellenc Q, Papo T, Sacre K. [Haemothorax revealing thoracic endometriosis]. Rev Med Interne 2020; 41:780-783. [PMID: 32709436 DOI: 10.1016/j.revmed.2020.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/09/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Thoracic endometriosis (TE) is a rare disorder affecting women during their reproductive years. Manifestations of TE include pneumothorax and haemothorax. Treatment is based on surgical and hormonal therapy that aims at eradicating existing endometrial thoracic plaques and to prevent reseeding from pelvic endometriosis. CASE REPORT We report the case of a 36 year-old young woman presenting thoracic endometriosis revealed by a recurring spontaneous, large and isolated right haemothorax. Diagnosis, pathogeny and treatment are discussed. CONCLUSION Thoracic endometriosis needs to be considered as a cause of haemothorax in women of childbearing age.
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Affiliation(s)
- M Barzilai
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Médecine Interne, Hôpital Bichat-Claude Bernard, Paris, France
| | - M Roriz
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Médecine Interne, Hôpital Bichat-Claude Bernard, Paris, France
| | - A Guyard
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Pathologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - M-P Debray
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Radiologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - Q Pellenc
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Chirurgie Vasculaire et Thoracique, Hôpital Bichat-Claude Bernard, Paris, France
| | - T Papo
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Médecine Interne, Hôpital Bichat-Claude Bernard, Paris, France
| | - K Sacre
- Université de Paris, Assistance Publique Hôpitaux de Paris, Département de Médecine Interne, Hôpital Bichat-Claude Bernard, Paris, France.
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27
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Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: A review. Reprod Med Biol 2020; 19:323-333. [PMID: 33071634 PMCID: PMC7542014 DOI: 10.1002/rmb2.12340] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background Extra‐pelvic endometriosis is a rare type of endometriosis, which occurs in a distant site from gynecological organs. The diagnosis of extra‐pelvic endometriosis can be extremely challenging and may result in a delay in diagnosis. The main objective of this review was to characterize abdominal wall endometriosis (AWE) and thoracic endometriosis (TE). Methods The authors performed a literature search to provide an overview of AWE and TE, which are the major types of extra‐pelvic endometriosis. Main findings Abdominal wall endometriosis includes scar endometriosis secondary to the surgical wound and spontaneous AWE, most of which occur in the umbilicus or groin. Surgical treatment appeared to be effective for AWE. Case reports indicated that the diagnosis and treatment of catamenial pneumothorax or endometriosis‐related pneumothorax (CP/ERP) are challenging, and a combination of surgery and postoperative hormonal therapy is essential. Further, catamenial hemoptysis (CH) can be adequately managed by hormonal treatment, unlike CP/ERP. Conclusion Evidence‐based approaches to diagnosis and treatment of extra‐pelvic endometriosis remain immature given the low prevalence and limited quality of research available in the literature. To gain a better understanding of extra‐pelvic endometriosis, it would be advisable to develop a registry involving a multidisciplinary collaboration with gynecologists, general surgeons, and thoracic surgeons.
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Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and Gynecology Doai Kinen Hospital Sumida-ku Japan.,Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
| | - Kaori Koga
- Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
| | - Yutaka Osuga
- Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
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28
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Thoracic endometriosis presenting as a catamenial hemothorax with discordant video-assisted thoracoscopic surgery. Radiol Case Rep 2020; 15:1419-1422. [PMID: 32642009 PMCID: PMC7334551 DOI: 10.1016/j.radcr.2020.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open
Abstract
Thoracic endometriosis is uncommon and may be overlooked, resulting in a delay in diagnosis. We describe the case of a 47-year-old woman presenting with acute onset pleuritic pain and hemothorax secondary to this rare entity. The diagnosis of thoracic endometriosis is driven by a compatible clinical history coupled with supportive imaging and immunohistochemical findings. Imaging features lack specificity, however, computed tomography and magnetic resonance imaging play an important role in identifying pleural/diaphragmatic involvement and excluding other more common diseases. Immunohistochemical pleural fluid analysis can confirm the presence of hormone receptor-positive endometrial glands and stroma. We illustrate a few potential diagnostic pitfalls, specifically the inconsistency in diagnostic yield of video-assisted thoracoscopic surgery/thoracentesis and the variable temporal association of patients’ symptoms and pathology with menstruation. Prompt identification of thoracic endometriosis is important as it enables early institution of therapy and limits future complications.
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29
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Chen CL, Huang WC, Cheng WC. Catamenial hemoptysis. QJM 2020; 113:357-358. [PMID: 31899498 DOI: 10.1093/qjmed/hcz328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- C-L Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - W-C Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - W-C Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
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30
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Nellihela L, Al-Adnani M, Kufeji D. Primary Umbilical Endometriosis in an Adolescent Girl: Unsuspected Pathology. European J Pediatr Surg Rep 2020; 8:e10-e13. [PMID: 32042547 PMCID: PMC7007811 DOI: 10.1055/s-0039-1700987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 11/19/2019] [Indexed: 12/19/2022] Open
Abstract
Endometriosis affects 7 to 10% of women of reproductive age. Primary umbilical endometriosis (PUE) is even rarer with unclear pathogenesis. We report a case of PUE possibly the youngest patient reported in the literature. A 16-year-old girl of African origin presented with painful umbilical lump for 2 to 3 months duration with background history of precocious puberty, cyclical vomiting, and menorrhagia. Clinical examination showed dark-colored, tender, irreducible umbilical lump. A provisional diagnosis of incarcerated umbilical hernia was made. Abdominal X-ray showed no features of intestinal obstruction. Ultrasound scan of the abdomen showed lump containing heterogeneous echogenic material measuring 2.0 × 1.5cm within the umbilicus with no visible bowel loops or peristalsis. This was reported as consistent with an umbilical hernia with narrow neck possibly containing mesentery or intra-abdominal fat. The patient underwent urgent exploration of umbilicus under general anesthetic. At operation, a dark-colored, firm mass was excised and sent for histology. The underlying fascia and peritoneum were repaired. Histological examination confirmed the excised tissue was endometriosis. Follow-up continues in the endometriosis clinic. Umbilical endometriosis should be considered in differential diagnoses of painful umbilical lesion in adolescent girls and women of reproductive age. Complete excision and histology are highly recommended for obtaining a definitive diagnosis, to exclude malignancy and to prevent recurrence.
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Affiliation(s)
- Leel Nellihela
- Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Mudher Al-Adnani
- Department of Histopathology, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Dorothy Kufeji
- Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
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31
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Gil Y, Tulandi T. Diagnosis and Treatment of Catamenial Pneumothorax: A Systematic Review. J Minim Invasive Gynecol 2020; 27:48-53. [DOI: 10.1016/j.jmig.2019.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/30/2019] [Accepted: 08/04/2019] [Indexed: 01/07/2023]
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32
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Dogra N, Luthra A, Chauhan R, Bajaj R, Gourav KP. Recurrent unilateral hemorrhagic pleural effusion: A rare manifestation of thoracic endometriosis syndrome. Ann Card Anaesth 2020; 23:521-523. [PMID: 33109818 PMCID: PMC7879902 DOI: 10.4103/aca.aca_17_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Unilateral recurrent pleural effusions are commonly encountered in critical care practice. Relevant clinical history, physical examination, radiology, and diagnostic thoracentesis usually identify the cause of pleural effusion in most cases. Thoracoscopy or video-assisted thoracic surgery may be required in selective cases. We report a case of 32-year-old female with recurrent unilateral hemorrhagic pleural effusion that was the presenting feature of thoracic endometriosis syndrome.
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Affiliation(s)
- Neeti Dogra
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Ankur Luthra
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Rajiv Chauhan
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Ritika Bajaj
- Department of Obstetrics and Gynaecology, Jindal IVF and Sant Memorial Nursing Home, Chandigarh, India
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33
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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:JSLS.2019.00029. [PMID: 31427853 PMCID: PMC6684338 DOI: 10.4293/jsls.2019.00029] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Endometriosis is characterized by the presence of endometrial-like glands and stroma outside the uterine cavity and is believed to affect 6%–10% of reproductive-age women. Endometriosis within the lung parenchyma or on the diaphragm and pleural surfaces produces a range of clinical and radiological manifestations. This includes catamenial pneumothorax, hemothorax, hemoptysis, and pulmonary nodules, resulting in an entity known as thoracic endometriosis syndrome (TES). Database: Computerized searches of MEDLINE and PubMed were conducted using the key words “thoracic endometriosis,” “catamenial pneumothorax,” “catamenial hemothorax,” and “catamenial hemoptysis.” References from identified sources were manually searched to allow for a thorough review. Conclusion: TES can produce incapacitating symptoms for some patients. Symptoms of TES are nonspecific, so a high degree of clinical suspicion is warranted. Medical management represents the first-line treatment approach. When this fails or is contraindicated, definitive surgical treatment for cases of suspected TES uses a combined video laparoscopy performed by a gynecologic surgeon and video-assisted thoracoscopic surgery performed by a thoracic surgeon. Postoperative hormonal suppression may further reduce disease recurrence.
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Affiliation(s)
- Camran Nezhat
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Wright State University, Dayton, Ohio, USA
| | - Leah Backhus
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Mailinh Vu
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA
| | - Nataliya Vang
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA
| | - Azadeh Nezhat
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA
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34
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Viti A, Bertoglio P, Roviglione G, Clarizia R, Ruffo G, Ceccaroni M, Terzi AC. Endometriosis Involving the Diaphragm: A Patient-Tailored Minimally Invasive Surgical Treatment. World J Surg 2019; 44:1099-1104. [DOI: 10.1007/s00268-019-05320-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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35
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La Rosa VL, De Franciscis P, Barra F, Schiattarella A, Török P, Shah M, Karaman E, Marques Cerentini T, Di Guardo F, Gullo G, Ponta M, Ferrero S. Quality of life in women with endometriosis: a narrative overview. Minerva Med 2019; 111:68-78. [PMID: 31755667 DOI: 10.23736/s0026-4806.19.06298-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Endometriosis is a very complex condition and has a significant impact on the quality of life, psychological wellbeing and interpersonal relationships of affected women. Endometriosis symptoms progressively impair the woman's ability to carry out some daily activities and result in a perception of worsening health status and overall well-being. The impact of these symptoms has been only partially investigated, and further studies and clinical insights are needed to fully understand the extent of this condition. It has been shown that endometriosis is associated with considerable direct and indirect costs, comparable to those of major worldwide chronic diseases such as diabetes. In addition, endometriosis-related symptoms substantially interfere with the employment of affected women, resulting in many cases in several working days missed. In this scenario, the aim of this narrative review is to provide a general overview of the psychological and social impact of this disease, as well as the effects of different therapeutic options, on quality of life and general well-being.
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Affiliation(s)
- Valentina L La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, Italy -
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Academic Unit of Obstetrics and Gynecology, San Martino University Hospital IRCCS, Genoa, Italy
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Erbil Karaman
- Department of Obstetrics and Gynecology, Yuzuncu Yıl University, Van, Turkey
| | | | - Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Giuseppe Gullo
- AOOR Villa Sofia Cervello, IVF Public Center, Palermo, Italy
| | - Marco Ponta
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Academic Unit of Obstetrics and Gynecology, San Martino University Hospital IRCCS, Genoa, Italy
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36
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Kim JH, Park SY. Recurrent hemoptysis in a 26-year-old woman with a ground-glass opacity lesion of the lung. Yeungnam Univ J Med 2019; 37:59-62. [PMID: 31661756 PMCID: PMC6986959 DOI: 10.12701/yujm.2019.00304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/23/2019] [Indexed: 11/18/2022] Open
Abstract
Hemoptysis is a major reason for emergency department (ED) visits. Catamenial hemoptysis (CH), a rare condition of thoracic endometriosis, can cause recurrent hemoptysis but is difficult to diagnose in the ED due to the scarcity of cases and nonspecific clinical findings. We report a case of a 26-year-old woman who presented to the ED with recurrent hemoptysis since 2 years without a definite cause. Her vital signs and blood test findings were unremarkable. Chest computed tomography (CT) did not show any specific lesions other than a non-specific ground-glass opacity pattern in her right lung. She was on day 4 of her menstrual cycle and her hemoptysis frequently occurred during menstruation. Although there was no histological confirmation, based on her history of hemoptysis during menstruation and no other cause of the hemoptysis, the patient was tentatively diagnosed with CH and was administered gonadotropin-releasing hormone. She had no recurrence of hemoptysis for 3 months. While CH is difficult to diagnose in the ED, the patient’s recurrent hemoptysis related to menstruation was a clue to the presence of CH. Therefore, physicians should determine the relationship between hemoptysis and menstruation for women of childbearing age presenting with repeated hemoptysis without a definite cause.
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Affiliation(s)
- Jong Ha Kim
- Department of Emergency Medicine, Kyungpook National University Chilgok-Hospital, Daegu, Korea
| | - Sin-Youl Park
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
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37
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Bolze PA, Descargues P, Poilblanc M, Cotte E, Sesques A, Paparel P, Charlot M, Hajri T, Rousset P, Golfier F. [Contribution of meb to endometriosis patients' diagnosis and treatment]. ACTA ACUST UNITED AC 2018; 47:3-10. [PMID: 30563784 DOI: 10.1016/j.gofs.2018.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Diagnosis and treatment of endometriosis may be complex and therefore justify the discussion of therapeutic decisions in a multidisciplinary endometriosis board (MEB). The development of endometriosis regional expert centers requires an assessment of the quality and relevance of MEB. METHODS Qualitiative retrospective study on patients whose management was discussed in Centre Hospitalier Lyon-Sud between June 2013 and December 2017. RESULTS Among 376 patients presented in MEB, 309 (80.2%) were painful and 184 (59.5%) had complex endometriosis. A complete clinical evaluation was performed in 120 (38.8%) patients. MRI was performed for 370 (98.4%) patients including 303 (81.9%) with a second reading by an expert radiologist. These second readings allowed a diagnosis correction in 88 (60.7 %) patients with complex endometriosis. MR enterography (27.8 %) and rectal endoscopic sonography (14.4%) were the most frequently used third-line exams to complete the initial imaging of digestive lesion in patients with rectal endometriosis. Surgery was proposed for 199 (52,9%) patients including 108 (58,7%) with complex endometriosis. CONCLUSION One of the major interests of MEB in endometriosis is the second reading of MRI, which, by identifying complex endometriosis initially undiagnosed or underestimated, enabled to better discuss the benefits/risks of therapeutic choices, and to organize complex surgeries when those were retained. The development of MEB in regional expert centers will contribute to optimizing the relevance of care for patients with endometriosis.
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Affiliation(s)
- P A Bolze
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P Descargues
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - M Poilblanc
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - E Cotte
- Service de chirurgie digestive, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - A Sesques
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Service de médecine de la reproduction, hospices civils de Lyon, université Claude-Bernard Lyon 1, hôpital Femme-Mère-Enfant, 56, boulevard Pinel, 69500 Bron, France
| | - P Paparel
- Service de chirurgie urologique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - M Charlot
- Service d'imagerie médicale, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - T Hajri
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P Rousset
- Service d'imagerie médicale, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - F Golfier
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Fournel L, Bobbio A, Robin E, Canny-Hamelin E, Alifano M, Regnard JF. Clinical presentation and treatment of catameinal pneumothorax and endometriosis-related pneumothorax. Expert Rev Respir Med 2018; 12:1031-1036. [PMID: 30457394 DOI: 10.1080/17476348.2018.1551133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Catamenial pneumothorax (CP) is defined as a recurrent spontaneous pneumothorax occurring in females of reproductive age. In the 'perimenstrual period,' it is still considered relatively rare although accounting for 20-35% of spontaneous pneumothoraces occurring in premenopausal women. It is the most frequent manifestation of thoracic endometriosis, which can also cause pneumothorax during the intermenstrual period (TER non-CP). Areas covered: In this article, we review and comment the clinical presentation, etiopathogenesis, diagnostic criteria, and therapeutic management of CP and TER non-CP. We particularly emphasize on the surgical optimal treatment and associated multidisciplinary care and follow-up. Electronic databases, mostly PubMed, were used for searching terms including 'catamenial pneumothorax' and 'thoracic endometriosis.' Expert commentary: Clinical presentation and imaging of CP and TER non-CP are often unspecific except for possible visualization of endometriosis foci or diaphragmatic lesions at computed tomography-scan or magnetic resonance imaging. Thus, we recommend careful interrogatory and intraoperative inspection for appropriate diagnosis and treatment of pneumothorax in women. Despite better awareness of surgical teams, CP and TER-non CP are still associated with high rates of postoperative recurrence (around 30%). We strongly advocate for a multidisciplinary management including early surgical and chemical pleurodesis, resection of all visible endometriosis-related lesions, hormonal blockade, and prolonged follow-up.
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Affiliation(s)
- Ludovic Fournel
- a Thoracic surgery department, Paris center hospitals , University Paris Descartes, APHP , Paris , France
| | - Antonio Bobbio
- a Thoracic surgery department, Paris center hospitals , University Paris Descartes, APHP , Paris , France
| | - Edouard Robin
- a Thoracic surgery department, Paris center hospitals , University Paris Descartes, APHP , Paris , France
| | - Emelyne Canny-Hamelin
- a Thoracic surgery department, Paris center hospitals , University Paris Descartes, APHP , Paris , France
| | - Marco Alifano
- a Thoracic surgery department, Paris center hospitals , University Paris Descartes, APHP , Paris , France
| | - Jean-François Regnard
- a Thoracic surgery department, Paris center hospitals , University Paris Descartes, APHP , Paris , France
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39
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Sanada T, Park J, Hagiwara M, Ikeda N, Nagai T, Matsubayashi J, Saito K. CT and MRI findings of bronchopulmonary endometriosis: a case presentation. Acta Radiol Open 2018; 7:2058460118801164. [PMID: 30288301 PMCID: PMC6168730 DOI: 10.1177/2058460118801164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 08/23/2018] [Indexed: 12/19/2022] Open
Abstract
Intrathoracic endometriosis is classified into pleurodiaphragmatic endometriosis
and bronchopulmonary endometriosis. Bronchopulmonary endometriosis is rare.
Computed tomography (CT) findings of bronchopulmonary endometriosis are lung
nodules, with or without cavities, or surrounding ground-glass opacities.
Features vary with menstrual status. Recently, the usefulness of magnetic
resonance imaging (MRI) was reported for diagnosis of intrathoracic
endometriosis, but most published reports were about pleurodiaphragmatic
endometriosis. We present CT and MRI findings of bronchopulmonary endometriosis
in the left lung that showed a gradually enlarging nodule with enhancing
area.
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Affiliation(s)
- Tomohide Sanada
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Jinho Park
- Department of Radiology, Tokyo Medical University, Tokyo, Japan.,Department of Radiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Masaru Hagiwara
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takeshi Nagai
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
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40
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Chamié LP, Ribeiro DMFR, Tiferes DA, Macedo Neto ACD, Serafini PC. Atypical Sites of Deeply Infiltrative Endometriosis: Clinical Characteristics and Imaging Findings. Radiographics 2018; 38:309-328. [PMID: 29320327 DOI: 10.1148/rg.2018170093] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Endometriosis is defined as the presence of endometrial tissue that is located outside the uterine cavity and associated with fibrosis and inflammatory reaction. It is a polymorphic and multifocal disease with no known cure or preventive mechanisms. Patients may be asymptomatic or may experience chronic pelvic pain, dysmenorrhea, dyspareunia, or infertility. The pelvic cavity is the most common location for endometriotic implants, which usually affect the retrocervical space, ovaries, vagina, rectosigmoid colon, bladder dome, and round ligaments. Atypical endometriosis is rare and difficult to diagnose. The most common atypical locations are the gastrointestinal tract, urinary tract, lung, umbilicus, inguinal area, breast, and pelvic nerves, as well as abdominal surgical scars. Gastrointestinal lesions are the most common extragenital manifestation, and the diaphragm is the most frequent extrapelvic site. The catamenial nature of the symptoms (occurring between 24 hours before and 72 hours after the onset of menstruation) may help suggest the diagnosis, but imaging by specialists is fundamental to evaluation. Depending on the area affected, radiography, ultrasonography, thin-section computed tomography, or magnetic resonance imaging can be used to assess suspected lesions. Because isolated extragenital endometriosis is rare, concomitant evaluation of the pelvic cavity is mandatory. Surgical excision is the only therapeutic option for definitive treatment, and comprehensive disease mapping is necessary to avoid residual disease. The authors review atypical locations for endometriosis and emphasize the most appropriate imaging protocols for investigation of various clinical manifestations. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Luciana P Chamié
- From the Department of Diagnostic Imaging, Chamié Imagem da Mulher, Rua Casa do Ator, 1117, cj 72, São Paulo, SP 04546-004, Brazil (L.P.C.); Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C., D.A.T., A.C.M.N.); Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Rodrigues Ribeiro, São Paulo, Brazil (D.M.F.R.R.); and Department of Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (P.C.S.)
| | - Duarte Miguel Ferreira Rodrigues Ribeiro
- From the Department of Diagnostic Imaging, Chamié Imagem da Mulher, Rua Casa do Ator, 1117, cj 72, São Paulo, SP 04546-004, Brazil (L.P.C.); Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C., D.A.T., A.C.M.N.); Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Rodrigues Ribeiro, São Paulo, Brazil (D.M.F.R.R.); and Department of Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (P.C.S.)
| | - Dario A Tiferes
- From the Department of Diagnostic Imaging, Chamié Imagem da Mulher, Rua Casa do Ator, 1117, cj 72, São Paulo, SP 04546-004, Brazil (L.P.C.); Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C., D.A.T., A.C.M.N.); Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Rodrigues Ribeiro, São Paulo, Brazil (D.M.F.R.R.); and Department of Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (P.C.S.)
| | - Augusto Cesar de Macedo Neto
- From the Department of Diagnostic Imaging, Chamié Imagem da Mulher, Rua Casa do Ator, 1117, cj 72, São Paulo, SP 04546-004, Brazil (L.P.C.); Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C., D.A.T., A.C.M.N.); Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Rodrigues Ribeiro, São Paulo, Brazil (D.M.F.R.R.); and Department of Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (P.C.S.)
| | - Paulo C Serafini
- From the Department of Diagnostic Imaging, Chamié Imagem da Mulher, Rua Casa do Ator, 1117, cj 72, São Paulo, SP 04546-004, Brazil (L.P.C.); Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C., D.A.T., A.C.M.N.); Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Rodrigues Ribeiro, São Paulo, Brazil (D.M.F.R.R.); and Department of Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (P.C.S.)
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41
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Larraín D, Suárez F, Braun H, Chapochnick J, Diaz L, Rojas I. Thoracic and diaphragmatic endometriosis: Single-institution experience using novel, broadened diagnostic criteria. J Turk Ger Gynecol Assoc 2018; 19:116-121. [PMID: 29865779 PMCID: PMC6085532 DOI: 10.4274/jtgga.2018.0035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To describe our experience with the multidisciplinary management of both thoracic/diaphragmatic endometriosis (TED), applying a broadened definition of the “Thoracic endometriosis syndrome (TES)” to define cases. Material and Methods: We present a retrospective series of consecutive patients affected by pathology-proven TED, treated at our institution, during a period of 7 years. Results: Five women were included. Two patients were referred due to catamenial chest/shoulder pain, one due to recurrent catamenial pneumothorax, and one due to new-onset diaphragmatic hernia. One patient had no thoracic symptoms, but diaphragmatic endometriosis was found during gynecologic laparoscopy for pelvic endometriosis. Endometriosis was histologically confirmed in all cases. After follow-up, all patients remain asymptomatic. Conclusion: Broadened TES criteria could increase the incidence of TED and determine better knowledge of this condition. Multidisciplinary, minimally invasive surgery is effective and safe, but should be reserved for tertiary referral centers.
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Affiliation(s)
- Demetrio Larraín
- Department of Obstetrics and Gynecology, Endometriosis Unit, Clínica Santa María, Santiago, Chile,Department of Obstetrics and Gynecology, Clínica Santa María, Santiago, Chile
| | - Francisco Suárez
- Department of Thoracic Surgery, Clínica Santa María, Santiago, Chile
| | - Hernán Braun
- Department of Obstetrics and Gynecology, Clínica Santa María, Santiago, Chile
| | - Javier Chapochnick
- Department of Hepatobiliary Surgery, Clínica Santa María, Santiago, Chile
| | - Lidia Diaz
- Department of Pathology, Clínica Santa María, Santiago, Chile
| | - Iván Rojas
- Department of Obstetrics and Gynecology, Clínica Santa María, Santiago, Chile
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42
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Kienlen A, Fernandez C, Henni-Laleg Z, Andre M, Gazaille V, Coolen-Allou N. [Thoracic endometriosis complicated with pneumopericard and iterative pneumothorax due to bullous dystrophy]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:104-108. [PMID: 29502894 DOI: 10.1016/j.pneumo.2018.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
Thoracic endometriosis is a rare entity characterized by presence of endometrial tissue in pleura, lung parenchyma or airways. Most frequent manifestations are catamenial pneumothorax, hemothorax, hemoptysis and pulmonary nodules. We report here a rare case of a woman with thoracic endometriosis who developed iterative pneumothorax and pneumopericardium on bilateral bullous pulmonary dystrophy. She was a 37-year-old woman without any tobacco exposure and with previous history of pleural tuberculosis treated 5 years earlier. She was first referred to our centre for right pleuro-pneumothorax and hemorrhagic ascites. Pleural fluid examinations did not show any tuberculosis relapse, the evolution was favorable after thoracic drainage and there was no parenchymal lung abnormality on CT scan after surgery. Celioscopic peritoneal examination revealed stage IV peritoneal endometriosis. One year later, she was admitted for left catamenial pneumothorax. Thoracic CT scan showed apparition of large subpleural bulla. She underwent thoracotomy for bulla resection and left partial pleurectomy. Two years later, she was hospitalized for right pneumothorax and compressive pneumopericardium. Surgical lung biopsies confirmed pleuropulmonary endometriosis. Thoracotomy was performed for talcage pleurodesis and diaphragmatic leakages sutures. Lung bulla are rare in thoracic endometriosis, mechanism of their formation remains unknown. Pericardial involvement is rare in endometriosis; we report here a unique case of pneumopericardium.
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Affiliation(s)
- A Kienlen
- Service de pneumologie, CHU F.-Guyon, allée des Topazes, 97400 Saint-Denis, La Réunion, France
| | - C Fernandez
- Service de pneumologie, CHU F.-Guyon, allée des Topazes, 97400 Saint-Denis, La Réunion, France
| | - Z Henni-Laleg
- Service de pneumologie, CHU F.-Guyon, allée des Topazes, 97400 Saint-Denis, La Réunion, France
| | - M Andre
- Service de pneumologie, CHU F.-Guyon, allée des Topazes, 97400 Saint-Denis, La Réunion, France
| | - V Gazaille
- Service de pneumologie, CHU F.-Guyon, allée des Topazes, 97400 Saint-Denis, La Réunion, France
| | - N Coolen-Allou
- Service de pneumologie, CHU F.-Guyon, allée des Topazes, 97400 Saint-Denis, La Réunion, France.
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43
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Merlot B, Ploteau S, Abergel A, Rubob C, Hocke C, Canis M, Fritel X, Roman H, Collinet P. [Extragenital endometriosis: Parietal, thoracic, diaphragmatic and nervous lesions. CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29530553 DOI: 10.1016/j.gofs.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
According to some studies, extragenital endometriosis represents 5% of the localisations. Its prevalence seems to be underestimated. The extra pelvic localisation can make the diagnosis more difficult. Nevertheless, the recurrent and catamenial symptomatology can evoke this pathology. Surgery seems to be the unique efficient treatment for parietal lesions. Pain linked to nervous lesions (peripheric and sacral roots) seems to be underestimated and difficult to diagnose because of various localisations. Neurolysis seems to have encouraging results. Diaphragmatic lesions are often discovered either incidentally during laparoscopy, or by pulmonary symptomatology as recurrent catamenial pneumothorax or cyclic thoracic pain. Surgical treatment seems as well to be efficient.
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Affiliation(s)
- B Merlot
- Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France.
| | - S Ploteau
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital mère-enfant, CHU de Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France
| | - A Abergel
- Médecine de la reproduction, clinique Jean-Villar, avenue Maryse-Bastié, 33520 Bruges, France
| | - C Rubob
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, CHRU de Lille, 59000 Lille, France
| | - C Hocke
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor-d'Aquitaine, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - M Canis
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC 1402, université de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - H Roman
- Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - P Collinet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, CHRU de Lille, 59000 Lille, France
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44
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Okimura H, Tatsumi H, Ito F, Yamashita S, Kokabu T, Kitawaki J. Endometrioid carcinoma arising from diaphragmatic endometriosis treated with laparoscopy: A case report. J Obstet Gynaecol Res 2018; 44:972-977. [PMID: 29400419 DOI: 10.1111/jog.13595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/31/2017] [Indexed: 11/29/2022]
Abstract
Malignant transformation of diaphragmatic endometriosis is rare. We present a case of endometrioid carcinoma arising from diaphragmatic endometriosis treated with laparoscopy. A 59-year-old primigravida woman who had undergone abdominal hysterectomy for adenomyosis at the age of 47 years was referred to our hospital for investigation of a tumor on the surface of the liver. An integrated positron emission tomography-computed tomography scan revealed a 3-cm nodule on the surface of the liver with abnormal fluorine-18-deoxyglucose accumulation. Partial resection of the diaphragm and liver was performed. Histopathological examination revealed an endometrioid carcinoma arising from diaphragmatic endometriosis. We additionally performed laparoscopic bilateral salpingo-oophorectomy and partial omentectomy. The resected tissues revealed no malignancy. Adjuvant chemotherapy with paclitaxel and carboplatin was administered. In cases of diaphragmatic tumors, endometriosis and its associated malignancies should be considered. Laparoscopic surgery is effective in patients with such conditions.
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Affiliation(s)
- Hiroyuki Okimura
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroshi Tatsumi
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumitake Ito
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Suguru Yamashita
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuya Kokabu
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Maniglio P, Ricciardi E, Meli F, Vitale SG, Noventa M, Vitagliano A, Valenti G, La Rosa VL, Laganà AS, Caserta D. Catamenial pneumothorax caused by thoracic endometriosis. Radiol Case Rep 2018; 13:81-85. [PMID: 29552245 PMCID: PMC5850814 DOI: 10.1016/j.radcr.2017.09.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Thoracic endometriosis syndrome is a rare form of extrapelvic endometriosis characterized by the presence of functioning endometrial tissue in pleura, lung parenchyma, and airways, associated with a high rate of infertility. CASE REPORT We have reported a case of successful management and treatment of thoracic endometriosis syndrome that occurred in a 37-year-old female patient. She underwent thoracoscopic resection of the lesion. During follow-up, we revealed the recurrence of a previously surgically treated thoracic endometriosis. She was initially treated with a gonadotropin-releasing hormone agonist; subsequently this was replaced by a prophylactic treatment with Dienogest. CONCLUSION The diagnosis of thoracic endometriosis is challenging. The first line of treatment is medical, whereas the surgical treatment is performed secondly. Moreover, surgical treatment can lead to a significant rate of recurrence, often reduced by a coadjutant medical treatment.
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Affiliation(s)
- Paolo Maniglio
- Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psycology, University of Rome “Sapienza”, Via di Grottarossa 1035, 00139 Rome, Italy
| | - Enzo Ricciardi
- Department of Gynecological Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Federica Meli
- Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psycology, University of Rome “Sapienza”, Via di Grottarossa 1035, 00139 Rome, Italy
| | - Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Amerigo Vitagliano
- Department of Woman and Child Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124 Catania, Italy
| | - Valentina Lucia La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Via Santa Sofia 78, 95124 Catania, Italy
| | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Donatella Caserta
- Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psycology, University of Rome “Sapienza”, Via di Grottarossa 1035, 00139 Rome, Italy
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46
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Aguinagalde B, Aranda JL, Busca P, Martínez I, Royo I, Zabaleta J. SECT Clinical practice guideline on the management of patients with spontaneous pneumothorax. Cir Esp 2017; 96:3-11. [PMID: 29248330 DOI: 10.1016/j.ciresp.2017.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 09/13/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022]
Abstract
This clinical practice guideline (CPG) emerges as an initiative of the scientific committee of the Spanish Society of Thoracic Surgery. We formulated PICO (patient, intervention, comparison, and outcome) questions on various aspects of spontaneous pneumothorax. For the evaluation of the quality of evidence and preparation of recommendations we followed the guidelines of the Grading of recommendations, Assessment, Development and Evaluation (GRADE) working group.
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Affiliation(s)
- Borja Aguinagalde
- Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, España.
| | | | - Pablo Busca
- Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, España
| | - Ivan Martínez
- Hospital Universitario 12 de Octubre, Madrid, España
| | - Iñigo Royo
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Jon Zabaleta
- Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, España
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Gui B, Valentini AL, Ninivaggi V, Miccò M, Zecchi V, Grimaldi PP, Cambi F, Guido M, Bonomo L. Shining light in a dark landscape: MRI evaluation of unusual localization of endometriosis. Diagn Interv Radiol 2017; 23:272-281. [PMID: 28703103 PMCID: PMC5508950 DOI: 10.5152/dir.2017.16364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/31/2017] [Accepted: 02/04/2017] [Indexed: 01/07/2023]
Abstract
Endometriosis is a disease distinguished by the presence of endometrial tissue outside the uterine cavity with intralesional recurrent bleeding and resulting fibrosis. The most common locations for endometriosis are the ovaries, pelvic peritoneum, uterosacral ligaments, and torus uterinus. Typical symptoms are secondary dysmenorrhea and cyclic or chronic pelvic pain. Unusual sites of endometriosis may be associated with specific symptoms depending on the localization. Atypical pelvic endometriosis localizations can occur in the cervix, vagina, round ligaments, ureter, and nerves. Moreover, rare extrapelvic endometriosis implants can be localized in the upper abdomen, subphrenic fold, or in the abdominal wall. Magnetic resonance imaging (MRI) represents a problem-solving tool among other imaging modalities. MRI is an advantageous technique, because of its multiplanarity, high contrast resolution, and lack of ionizing radiation. Our purpose is to remind the radiologists the possibility of atypical pelvic and extrapelvic endometriosis localizations and to illustrate the specific MRI findings. Endometriotic tissue with hemorrhagic content can be distinguished from adherences and fibrosis on MRI imaging. Radiologists should keep in mind these atypical localizations in patients with suspected endometriosis, in order to achieve the diagnosis and to help the clinicians in planning a correct and complete treatment strategy.
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Affiliation(s)
- Benedetta Gui
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Anna Lia Valentini
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Valeria Ninivaggi
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Maura Miccò
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Viola Zecchi
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Pier Paolo Grimaldi
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Francesco Cambi
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Maurizio Guido
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Lorenzo Bonomo
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
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Bourgioti C, Preza O, Panourgias E, Chatoupis K, Antoniou A, Nikolaidou ME, Moulopoulos LA. MR imaging of endometriosis: Spectrum of disease. Diagn Interv Imaging 2017; 98:751-767. [PMID: 28652096 DOI: 10.1016/j.diii.2017.05.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 05/22/2017] [Accepted: 05/28/2017] [Indexed: 02/07/2023]
Abstract
Endometriosis is a common gynecological disorder defined by the presence of endometrial tissue outside the uterus. It is the most common cause of chronic pelvic pain and typically affects the ovaries, uterine ligaments, peritoneum, tubes, rectovaginal septum and bladder. It may, however, be found at various extrapelvic sites, including the perineum, liver, pancreas, lung or even the central nervous system, and in such cases, diagnosis may be quite challenging. Even though definitive diagnosis requires laparoscopy, preoperative identification of endometriosis is important not only to differentiate it from other diseases with similar clinical presentations but also, for accurate presurgical mapping, since complete removal of all endometriotic foci is critical for the effective treatment of the patient's symptoms. Ultrasound is performed initially, but magnetic resonance imaging (MRI) is increasingly being used, particularly when sonographic findings are unclear, when deep pelvic endometriosis is suspected or when surgery is planned, as it provides better contrast resolution and a larger field of view compared to ultrasound. In this article, we will discuss distinctive MRI appearances of endometriotic foci and we will review common and uncommon locations of endometriosis within the body, in an attempt to familiarize radiologists with its wide spectrum of manifestations.
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Affiliation(s)
- C Bourgioti
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - O Preza
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - E Panourgias
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - K Chatoupis
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - A Antoniou
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - M E Nikolaidou
- Department of Gynaecology and Obstetrics, Rea maternity hospital, 383, Sygrou Ave., 17564 Athens, Greece.
| | - L A Moulopoulos
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
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Pankratjevaite L, Samiatina-Morkuniene D. A case report of thoracic endometriosis - A rare cause of haemothorax. Int J Surg Case Rep 2017; 33:139-142. [PMID: 28315819 PMCID: PMC5358902 DOI: 10.1016/j.ijscr.2017.02.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 11/24/2022] Open
Abstract
The diagnosis of thoracic endometriosis is complicated, because it has no specific symptoms and signs, and often delayed. TES should be suspected in a reproductive age woman with exacerbating symptoms during the menstruation. TES treatment should be started with medicine. If medical therapy fails, surgical treatment should be performed. Our case report shows that TES may be the cause of dangerous situation when an urgent operation must be performed. It is the first case of TES that has required urgent surgical treatment in our hospital in past fifteen years. Not all clinicians know that TES sometimes might complicate to pneumothorax or massive bleeding, which might cost a patient’s life. We suggest performing VATS as soon as possible for reproductive age woman with unknown aetiology of pneumothorax or haemothorax to find out the lesions in pleural cavity and start appropriate treatment on time.
Introduction The presence of endometrial tissue in airways, pleura and lung parenchyma is called thoracic endometriosis syndrome (TES). It is a rare pathology, and typically consists of catamenial pneumothorax, haemothorax, haemoptysis, and pulmonary nodules. We report a case of a 36-year-old woman with thoracic endometriosis causing catamenial haemothorax. Conclusions The diagnosis of thoracic endometriosis is complicated and often delayed. TES should be suspected in a reproductive age woman with exacerbating symptoms during the menstruation. Treatment may be medical and surgical.
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Affiliation(s)
- Lina Pankratjevaite
- Department of Surgery, Medical Academy, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Diana Samiatina-Morkuniene
- Department of Thoracic Surgery, Medical Academy, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania.
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Ottolina J, De Stefano F, Viganò P, Ciriaco P, Zannini P, Candiani M. Thoracic Endometriosis Syndrome: Association With Pelvic Endometriosis and Fertility Status. J Minim Invasive Gynecol 2017; 24:461-465. [PMID: 28069481 DOI: 10.1016/j.jmig.2016.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/13/2016] [Accepted: 12/31/2016] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE To evaluate associations among catamenial pneumothorax, pelvic endometriosis, and fertility status. DESIGN Retrospective study (Canadian Task Force classification II-2). SETTING Departments of Thoracic Surgery and Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy. PATIENTS Sixteen females referred to the Department of Thoracic Surgery for treatment of spontaneous pneumothorax between January 2001 and January 2014 and referred to the outpatient clinic for gynecologic follow-up. INTERVENTIONS Thoracoscopy for catamenial pneumothorax and laparoscopy for pelvic endometriosis. MEASUREMENTS AND MAIN RESULTS Characteristics of the patients, the presence of endometriosis, and their fertility status were statistically analyzed. Pelvic endometriosis was diagnosed in 9 patients (56.3%), but 6 patients did not undergo a laparoscopic procedure to confirm or exclude the disease. Seven of the affected patients (77.8%) had stage III-IV endometriosis. Two-thirds of the patients with pelvic endometriosis who attempted conception conceived spontaneously, as did all of the patients without histopathological confirmation of endometriosis. CONCLUSION Thoracic endometriosis syndrome, characterized mainly by catamenial pneumothorax, is a relevant condition in patients affected by endometriosis. However, few previous studies have analyzed this condition from a gynecologic standpoint, in terms of characteristics of endometriosis and fertility status of affected women. Our findings support the presence of a strong association between catamenial pneumothorax and pelvic endometriosis, as well as a minimal effect of catamenial pneumothorax on fertility status, even in the presence of pelvic endometriosis.
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Affiliation(s)
- Jessica Ottolina
- Gynecology Department, San Raffaele Scientific Institute, Milan, Italy.
| | | | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Paola Ciriaco
- Thoracic Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Piero Zannini
- Thoracic Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Gynecology Department, San Raffaele Scientific Institute, Milan, Italy
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