Thoracic Endometriosis: Revisiting the Association Between Clinical Presentation and Thoracic Pathology Based on Thoracoscopic Findings in 110 Patients
Channabasavaiah, Anitha D. MD; Joseph, Jose Vempilly MD
Thoracic endometriosis (TE) is a rare disorder affecting women during their reproductive years. The etiopathogenesis of this disease is not well understood; the prevailing opinion is based on analysis obtained from case reports and small case series. A 1996 review of TE was not able to address the association between clinical presentation and thoracic pathology due to a paucity of thoracoscopic findings in these earlier cases. Since the year 2001, most published cases and series have included thoracoscopic findings. Therefore, we compiled data from case reports and case series published in English from January 2001 to July 2007 to analyze the demographics, clinical characteristics, and thoracoscopic findings, and to study the relationship between thoracoscopic findings and clinical presentation in patients with thoracic endometriosis.
The clinical presentations in 110 patients were as follows: pneumothorax in 79 (72%), hemoptysis in 16 (14%), hemothorax in 13 (12%), and lung mass in 2 (2%). Ninety-one of the 110 (85%) patients underwent thoracotomy or thoracoscopy. The right hemithorax was more often affected (85%) than the left side (p = 0.008). The mean (standard deviation [SD]) age of all patients was 34 (7.6 yr). The mean age of patients presenting with hemoptysis (25.9 ± 4.6 yr) was significantly lower than the age of those presenting with pneumothorax and hemothorax (p < 0.01). There was no significant association between the presence of diaphragmatic defects and pneumothorax (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.05-1.58; p = 0.23). The presence of parietal and visceral pleural implants was associated with a fivefold increase in hemothorax (OR, 5.55; 95% CI, 1.20-25.53; p < 0.01). Hemoptysis occurring in younger subjects may be the earliest manifestation of parenchymal lung involvement in TE. Diaphragmatic defects do not increase the risk for pneumothorax. Hemothorax reflects an increased burden of pleural implants in TE.
Through Dr. Wallace’s book and her international educational outreach efforts, the plight of those with endometriosis that affects the lung and/or colon is no longer one paved with despair and quiet acceptance. It has been unearthed as a benign disease that can be conquered with the proper understanding of the diverse specialists that are often the first to see a patient present with symptoms. Dr. Wallace’s mission simple, yet mighty: “My mission is to make every woman,the men who love them and the physicians who treat them aware of this benign disease!”
We are almost half way through 2010. Catamenial Pneumothorax is no longer considered rare! " Catamenial pneumothorax accounts for approximately one third of cases of spontaneous pneumothoraces in women referred for surgery" Catamenial pneumothorax : Current Opinion in Pulmonary Medicine
Thanks to the Endometriosis Foundation of America (EFA) we have the first academic conference of its kind originating in the
I would like to thank "HOUSE" for doing the proper research and accurately portraying the devastation & destruction endometriosis can cause. The episode "The Greater Good final diagnosis Ectopic Endometriosis" aired Feb 2, 2009.
We ended 2008 with great success and enlightenment! An incredible amount of information has surfaced about catamenial pneumothoracies diagnosis and treatment.
2007 was a great year for Lung Endometriosis awareness.
Two medical reference books
& 
recognized lung endometriosis. 2006 was a productive year for Catamenial Pneumothorax awareness, and I was instrumental in the completion of the addition of Catamenial Pneumothorax to the list of rare diseases at the National Institutes of Health Office of Rare Diseases (ORD) July 2006.
ORD characterizes a rare or orphan disease as a disease or condition that affects fewer than 200,000 persons. Since endometriosis effects millions of women worldwide, I believe the lung consortions which have been contacted to determine worldwide numbers will soon prove Catamenial Pneumothorax is under recognized and under diagnosed. Literature research and all related information can be obtained at 
and most recent articles on CP 
. 
Endometriosis is Estrogen driven and responds to a woman's hormonal cycle. Endometrial Implants found in other areas of the body bleed monthly. There are currently 3 theories as to why this occurs, and there is no cure. (Halban's Theory) Vascular/Lymph transmission, menses flows backwards allowing endometriol cells to enter the colon and chest. (Meye's Theory) also known as coelmic metaplasia states cells can change from one type to another, but arise from the same embryologic origin or precursor. The third is trauma or manipulation of the uterine tissue causes endometriol tissue to migrate through blood vessels. In 2006, the World Endometriosis Research Foundation was launched. The Foundation is a registered charity in the United Kingdom, but will operate globally. This global endometriosis project is initiated jointly by three professional organizations: The American Society for Reproductive Medicine (ASRM), the European Society for Human Reproduction and Embryology (ESHRE) and the World Endometriosis Society (WES). Congratulations to Lone Hummelshoj nominated as Chief Executive.