J. Joseph et Sa. Sahn, THORACIC ENDOMETRIOSIS SYNDROME - NEW OBSERVATIONS FROM AN ANALYSIS OF 110 CASES, The American journal of medicine, 100(2), 1996, pp. 164-170
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.