Thoracic Endometriosis Syndrome is Strongly Associated With Severe Pelvic Endometriosis and Infertility

Study ObjectiveTo evaluate the clinical and surgical features of thoracic endometriosis syndrome (TES) represented by catamenial pneumothorax and pelvic endometriosis and to describe their association with infertility.DesignRetrospective clinical study (Canadian Task Force classification: II-2).SettingAcademic tertiary referral endometriosis center.PatientsSeven patients who had undergone surgery because of thoracic and pelvic endometriosis between 2004 and 2010.InterventionsThoracic and pelvic exploration and treatment and fertility treatment.Measurements and Main ResultsConcurrently, thoracic and pelvic endometriosis, and subsequent fertility were determined during long-term follow-up after combined surgical and pharmacologic interventions. The most frequent thoracic finding was diaphragmatic implants. Except for 1 patient with recurrent pleurodesis at 1 month after video-assisted thoracoscopy, no patients experienced recurrence of thoracic symptoms during a median (range) follow-up of 31.4 (1–61) months. Severe pelvic endometriosis was diagnosed in 6 patients with notable urologic and gastrointestinal tract involvement. Only 1 patient with catamenial pneumothorax had no macroscopic pelvic lesions. There was a considerable delay between the onset of pelvic symptoms and diagnosis. Median postoperative follow-up was 31.5 (7–84) months. Most patients who tried to conceive had primary infertility.ConclusionThoracic endometriosis syndrome, represented by catamenial pneumothorax, was strongly associated with severe pelvic endometriosis and a high rate of infertility. Inasmuch as many patients with thoracic endometriosis syndrome are treated by thoracic surgeons using video-assisted thoracoscopy, it is desirable to involve an experienced gynecologist who can diagnose and treat concurrent pelvic endometriosis.