THORACIC ENDOMETRIOSIS SYNDROME - NEW OBSERVATIONS FROM AN ANALYSIS OF 110 CASES

PURPOSE: To determine the demographics, clinical presentations, pathol ogical findings, and the effectiveness of treatment in 110 patients wi th thoracic endometriosis syndrome (TES). METHODS: Retrospective analy sis based on data published in the English medical literature. RESULTS : The mean age at presentation of TES was 35 +/- 0.6 years (+/- standa rd error of the mean) with a range from 15 to 54. The trends of age-sp ecific incidence for pelvic endometriosis and TES were similar. The pe ak incidence for pelvic endometriosis occurred between 24 and 29 years , whereas the peak incidence for TES was between 30 and 34 years. Pneu mothorax 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 as sociated with presence of pleural and pelvic endometriosis compared wi th other manifestations (P <0.003, P <0.02). Compared with hormonal tr eatment, surgical pleurodesis resulted in low recurrence rate for pneu mothorax at 6 months (P = 0.002) and 12 months (P = 0.03) of follow-up . There was no significant difference in recurrence rate for pneumotho rax or hemothorax among patients treated with danazol or oral contrace ptives. CONCLUSIONS: There is a significant association between the pr esence of pelvic endometriosis and TES, with the latter occurring appr oximately 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 a nd 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. Ea rlier diagnosis and effective therapy of TES can decrease the morbidit y of this disease in women during their reproductive period.