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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; 72:668-673. [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] [MESH Headings] [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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Ordóñez Lozano PA. [Catamenial pneumothorax with persistent air leak]. An Sist Sanit Navar 2024; 47:e1069. [PMID: 38451043 PMCID: PMC10938963 DOI: 10.23938/assn.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
Catamenial pneumothorax is a spontaneous recurrent pneumothorax that occurs in women of reproductive age and in temporal relationship with the menses. It usually occurs within 24 hours before or 72 hours after the start of the menstrual cycle; however, multiple variations have been described in terms of the temporal relationship. To date, it is considered a rare condition; this may be justified by the limited available knowledge on this disease leading to misdiagnosis. Often, making a diagnosis of catamenial pneumothorax is complicated; it mainly depends on the medical history; also, it may be a surgical or histopathological diagnosis. Management strategies for catamenial pneumothorax may include combinations of hormonal therapy, pleurodesis, lung parenchyma resection, and diaphragm resection/repair. The aim of reporting this atypical case of catamenial pneumothorax is to highlight the relevance of having the adequate knowledge on this entity so it does not go unnoticed despite its apparent low incidence.
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Lyons KM, Brady PR. Intrathoracic endometriosis resulting in catamenial pneumothorax. BMJ Case Rep 2024; 17:e255636. [PMID: 38191226 PMCID: PMC10806970 DOI: 10.1136/bcr-2023-255636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
A woman in her early 40s presented with right-side chest pain radiating to the ipsilateral shoulder coinciding with her menstrual periods. She complained of worsening dysmenorrhoea over the preceding 6 months. Chest radiograph was notable for pneumothorax. Conservative management through hormonal suppression was initially pursued but proved ineffective for preventing recurrence. The patient ultimately underwent video-assisted diagnostic thoracoscopic surgery through robotic approach; intraoperative findings confirmed the presence of endometrial deposits of the diaphragm, confirming the cause of the patient's catamenial pneumothorax. The patient recovered well and was started on a gonadotropin-releasing hormone antagonist 3 weeks following her operation.
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Affiliation(s)
- Kenya Marie Lyons
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Patricia Rios Brady
- Department of Family and Preventative Medicine, University of California San Diego, San Diego, California, USA
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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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