Thoracic endometriosis syndrome: New observations from an analysis of 110 cases

PURPOSE: To determine the demographics, clinical presentations, pathological findings, and the effectiveness of treatment in 110 patients with thoracic endometriosis syndrome (TES). METHODS: Retrospective analysis based on data published in the English medical literature. RESULTS: The mean age at presentation of TES was 35 +/- 0.6 years (+/- standard error of the mean) with a range from 15 to 54. The trends of age-specific incidence for pelvic endometriosis and TES were similar. The peak incidence for pelvic endometriosis occurred between 24 and 29 years, whereas the peak incidence for TES was between 30 and 34 years. Pneumothorax was the most common presentation, occurring in 80 of 110 (73%), followed by hemothorax in 15 (14%), hemoptysis in 8 (7%), and lung nodules in 7 (6%). The right hemithorax was involved in more than 90% of all manifestations except for nodules. Hemothorax was more often associated with presence of pleural and pelvic endometriosis compared with other manifestations (P <0.003, P <0.02). Compared with hormonal treatment, surgical pleurodesis resulted in low recurrence rate for pneumothorax at 6 months (P = 0.002) and 12 months (P = 0.03) of follow-up. There was no significant difference in recurrence rate for pneumothorax or hemothorax among patients treated with danazol or oral contraceptives. CONCLUSIONS: There is a significant association between the presence of pelvic endometriosis and TES, with the latter occurring approximately 5 years later. Pneumothorax is the most common manifestation. The most plausible explanation for pathogenesis involves peritoneal-pleural movement of endometrial tissue through diaphragmatic defects and microembolization through pelvic veins. Diagnosis is established on clinical grounds in most cases. Surgical pleural abrasion is superior to hormonal treatment in the long-term management of pneumothorax. Earlier diagnosis and effective therapy of TES can decrease the morbidity of this disease in women during their reproductive period.