Thoracic endometriosis syndrome: Comparison between catamenial pneumothorax or endometriosis-related pneumothorax and catamenial hemoptysis
Abstract
OBJECTIVES To evaluate the clinical features of thoracic endometriosis syndrome (TES) represented by catamenial pneumothorax (CP), endometriosis-related pneumothorax (ERP), and catamenial hemoptysis (CH). STUDY DESIGN In this retrospective study, we enrolled 25 patients with TES, 18 of whom had CP/ERP and 7 had CH, to investigate the clinical presentation, effectiveness of treatment, and recurrence rates in these disorders. RESULTS The age at onset was significantly lower in patients with CH than in patients with CP/ERP (P < 0.05). In 94.4% of patients with CP/ERP, pneumothorax was observed on either the right side or bilaterally, however there was no tendency toward laterality of CH among our cases. In our study, patients with CP/ERP predominantly underwent surgical management and the recurrence rate during treatment was higher in patients with CP/ERP than in those with CH. We found that the recurrence frequency of CP/ERP was lowest under the combination therapy with thoracic surgery and postoperative hormonal therapy. CONCLUSION Our findings suggest that CP/ERP and CH are different pathological conditions and CP/ERP is more difficult to manage than CH.
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Isolated diaphragmatic endometriosis is typically asymptomatic but can result in irritation of the phrenic nerve, producing catamenial pain.
“Outside of the well-established clinical manifestations of TES, cases of isolated diaphragmatic endometriosis are typically asymptomatic but can result in irritation of the phrenic nerve. This can produce a syndrome of only catamenial pain, presenting as cyclic neck, shoulder, right upper quadrant, or epigastric pain.2,9,10,31,35–37”
From Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management (2019) · cites this paper as [35]
Bronchoscopy, thoracoscopic biopsies, and cytological washings are often limited because endometrial implants tend to lie peripherally rather than along the mucosa of large bronchi.
“Bronchoscopy, thoracoscopic biopsies, and cytological washings are often limited due to the propensity of endometrial implants to lie peripherally rather than along the mucosa of large bronchi.35,45–48”
From Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management (2019) · cites this paper as [35]
Several studies have suggested that combined surgical and postoperative hormonal therapy reduces recurrence.
“Several studies have suggested the utility of combined surgical and postoperative hormonal therapy to reduce recurrence.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [76]
CP has occurred overwhelmingly at the right side, which is over 90% of CP cases.
“CP has occurred overwhelmingly at the right side, which is over 90% of CP cases.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [76]
The age at onset was 8-10 years younger in catamenial hemoptysis than in catamenial pneumothorax or endometriosis-related pneumothorax.
“The age at onset was 8‐10 years younger in CH than in CP/ERP.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [76]
According to recent studies, the average age at diagnosis ranged from 25.9 to 29.6 years.
“According to recent studies, the average age at diagnosis ranged from 25.9 to 29.6 years.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [76]
Catamenial pneumothorax or endometriosis-related pneumothorax has a high recurrence rate both after surgery and hormonal therapy.
“This is in contrast to CP/ERP, which has a high recurrence rate both after surgery and hormonal therapy.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [76]
Our group reported that the combination of surgery and hormonal therapy tended to have a lower recurrence frequency than either surgery alone or hormonal therapy alone.
“Our group reported that the combination of surgery and hormonal therapy tended to have a lower recurrence frequency than either surgery alone or hormonal therapy alone.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [76]
Recurrence rate after surgery is still high.
“However, the recurrence rate after surgery is still high,”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [76]
Recurrence rate has been reported to be 14.3%-46.7% during a follow-up period of 12 months or more after surgery.
“The recurrence rate has been reported to be 14.3%‐46.7% during a follow‐up period of 12 months or more after surgery.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [76]
Current management still has a high recurrence rate for catamenial pneumothorax or endometriosis-related pneumothorax.
“and current management still has a high recurrence rate for CP/ERP.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [76]
In our recent study, catamenial hemoptysis patients consequently had no surgical therapy, unlike catamenial pneumothorax or endometriosis-related pneumothorax patients.
“and consequently no surgical therapy, unlike CP/ERP patients.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [76]
In our recent study, all catamenial hemoptysis patients experienced symptomatic improvement with hormone therapy.
“In our recent study, all CH patients experienced symptomatic improvement with hormone therapy,”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [76]
There are cases where recurrence of pneumothorax occurs even during hormone therapy after surgery.
“there are cases where recurrence of pneumothorax occurs even during hormone therapy after surgery.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [76]
In our recent study, catamenial hemoptysis patients had no recurrence during hormone therapy.
“no recurrence during hormone therapy,”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [76]
Bronchial biopsy, thoracoscopic biopsies and cytological washings have been of limited use in diagnosing thoracic endometriosis syndrome.
“Bronchial biopsy, thoracoscopic biopsies and cytological washings have been of limited use.”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [24]
Endometrial implants tend to lie on the peripheries of large bronchi rather than on the mucosa and are often missed.
“Endometrial implants tend to lie on the peripheries of large bronchi, rather than on the mucosa, and are often missed [ 24 ].”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [24]
Fukuda et al. found a higher recurrence rate following surgery in patients with symptoms of catamenial pneumothorax compared to catamenial hemoptysis.
“Fukuda et al. found a higher recurrence rate following surgery in patients with symptoms of catamenial pneumothorax when compared to catamenial hemoptysis [ 24 ].”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [24]
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- Authors
- Fukuda, S., Hirata, T., Neriishi, K., Nakazawa, A., Takamura, M., Izumi, G., Harada, M., Hirota, Y., Koga, K., Wada-Hiraike, O., Fujii, T., & Osuga, Y.
- Affiliations
- The University of Tokyo (JP)
- Corresponding author
- Hirata, Tetsuya
- ORCID
- Venue
- European Journal of Obstetrics & Gynecology and Reproductive Biology
- Publisher
- Elsevier BV
- Published
- 2018-06
- Volume
- 225
- Pages
- 118-123
- ISSN
- 0028-2243 (ISSN-L)
- 0301-2115
- OpenAlex
- W2801219482
- Semantic Scholar
- f5c3d6d86da4257245e23776b1529e06ad0fb3ac
- Cited by
- 44
- References
- 26
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 5 · 2023: 5 · 2022: 7 · 2021: 8 · 2020: 4 · 2019: 7 · 2018: 1
- FWCI
- 5.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- European Journal of Obstetrics & Gynecology and Reproductive Biology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ministry of Health, Labour and Welfare
- Japan Agency for Medical Research and Development
- Ministry of Education, Culture, Sports, Science and Technology
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pleural and Pulmonary Diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Medical Imaging and Pathology Studies
- Keywords
- thoracic endometriosis syndrome, catamenial pneumothorax, catamenial hemoptysis, recurrent pneumothorax, surgical management, postoperative hormonal therapy, combination therapy, clinical features
- MeSH terms
- Adolescent, Adult, Endometriosis, Female, Humans, Middle Aged, Pneumothorax, Thoracic Diseases, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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