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Endometriosis as a systemic pathology: a case report


Obstetrics & Gynecology International Journal
Shadi Rezai,1 Alexander G Graves,2 Cassandra E Henderson,3Xiaoming Guan1

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Abstract

Background: Thoracic endometriosis is the most frequent extra-pelvic location of endometrial lesions. Because thoracic endometriosis is an unusual and uncommon diagnosis in women, it is crucial that patients with catamenial chest pain and previous history of endometriosis undergo a thorough work-up. Due to the rarity of this disease a high index of clinical suspicion is imperative to make a diagnosis. Consequently, due to the multi-organ involvement of this disease a multi-disciplinary team is required for appropriate investigation, diagnosis, and treatment.

Presentation of the case: Patient is a 29-year-old Gravida 2, Para 0020 with a known history of pelvic endometriosis, confirmed by histopathology, was referred to our clinic for evaluation of her chronic pelvic pain, endometriosis, catamenial dyspnea, cyclic chest pain, dysmenorrhea, and menorrhagia.

The patient underwent robotic single-incision laparoscopic surgery (SILS) resection of endometriosis, ovarian cystectomy, lysis of adhesions, and cystoscopy by the Minimally Invasive Gynecologic Surgery (MIGS) team. Afterwards, the thoracic surgery team performed bilateral video-assisted laparoscopy surgery (VATS) with assistance from the MIGS to help identify suspicious lesions. Intraoperative evaluation revealed thoracic endometriosis confined to the pleura of the lungs and the diaphragm and were resected. Based on the clinical presentation and intraoperative findings the patient was diagnosed with thoracic endometriosis.

Conclusion: Thoracic endometriosis is an unusual, but relatively common diagnosis in women with catamenial chest pain, catamenial dyspnea, and previous history of confirmed endometriosis. Due to the impacts on patient quality of life and the potential complications of thoracic endometriosis, we find it imperative to investigate this patient population.

Keywords

Catamenial hemoptysis, Catamenial Pneumothorax, Chronic pelvic pain, Catamenial symptoms, Cyclic chest pain, Diaphragmatic endometriosis, Dienogest, Dyspnea, Elagolix (orilissa), Endometriosis, Endometriosis complications, Endometriosis related pneumothorax, Endometriosis surgery, Minimally invasive gynecologic surgery, Multidisciplinary team, orilissa, Thoracic endometriosis, Thoracic endometriosis syndrome, Video-assisted laparoscopy surgery

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