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Diaphragmatic endometriosis and thoracic endometriosis syndrome: a review on diagnosis and treatment

  • Thiers Soares ORCID logo , Marco Aurelio Oliveira , Karen Panisset , Nassir Habib , Sara Rahman , Jordan S. Klebanoff and Gaby N. Moawad ORCID logo EMAIL logo
Published/Copyright: February 18, 2021
Hormone Molecular Biology and Clinical Investigation
From the journal Hormone Molecular Biology and Clinical Investigation Volume 43 Issue 2

Abstract

Endometriosis of the diaphragm has been gaining more attention in the practice of gynecologists and thoracic surgeons in recent years. Understanding related symptoms and developing imaging methods have improved their approach. A review of the literature was performed with the aim to report on incidence, diagnosis, treatment and prognosis of diaphragmatic endometriosis. We also cover the issue of the Thoracic Endometriosis Syndrome (TES). Complaints of cyclic chest pain in patients of childbearing age should have as differential diagnosis the presence of thoracic endometriosis. Catamenial pneumothorax is the main manifestation of diaphragmatic endometriosis and Thoracic Endometriosis Syndrome. Other possible manifestations are hemothorax, pulmonary nodules, and diaphragmatic hernia. Despite the possibility of drug treatment, many patients will be submitted to surgical treatment. The minimally invasive approach should be the one of choice. The robotic pathway allows for an easier approach due to its ability to articulate robotic arms, allowing the treatment of lesions in hard-to-reach locations, such as the posterior part of the diaphragm. Multidisciplinary treatment should be used in most cases, as only abdominal approach is not sufficient for the diagnosis and treatment of lesions in the thoracic cavity. The approach of endometriosis of the diaphragm and Thoracic Endometriosis Syndrome should be multidisciplinary, allowing the improvement of quality of life in most patients.

Highlights

  1. The incidence of diaphragmatic endometriosis is increasing

  2. Use of MRI and/or CT will allow better diagnosis

  3. Although medical treatment is an option, usually patient will need surgical approach

  4. Minimally invasive approach should be the gold standard (laparoscopy or robotics)

  5. Multidisciplinary management is mandatory

  6. Randomized controlled trials should be done to enhance treatment

  7. Early referral of patients with thoracic endometriosis will allow a better successful treatment rate

Keywords: diaphragm; endometriosis; laparoscopy; robotics; thoracic syndrome
Corresponding author: Gaby N. Moawad, MD, Department of Obstetrics & Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC 20037, USA, E-mail:

  1. Research funding: Authors state no funding involved.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Dr. Moawad is a speaker for Intuitive Surgical. No other conflicts of interest declared.

  4. Informed consent: Informed consent is not applicable.

  5. Ethical approval: The conducted research is not related to either human or animals use.

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Received: 2020-09-16
Accepted: 2021-02-03
Published Online: 2021-02-18

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Special Issue 1: Adenomyosis and Endometriosis: An Update; Edited by René Druckmann and Adolf E. Schindler
  3. Review Articles
  4. The impact of endometriosis on the outcome of assisted reproductive techniques: role of fertility preservation
  5. A narrative review of functional outcomes following nerve-sparing surgery for deeply infiltrating endometriosis
  6. Appropriate surgical management of ovarian endometrioma: excision or drainage?
  7. Diaphragmatic endometriosis and thoracic endometriosis syndrome: a review on diagnosis and treatment
  8. Rates of anastomotic leak and fistula following surgical management of bowel endometriosis: a comparison of shaving, discoid excision, and segmental resection
  9. Endometriosis at all ages: diagnostic ultrasound
  10. Special Issue 2: Fertility Preservation in Cancer Patients and Survivors; Edited by René Druckmann and Adolf E. Schindler
  11. Opinion Paper
  12. Quality of life and sexual dysfunction in gynaecological cancer patients: a psychosomatic approach
  13. Review Articles
  14. Fertility preservation in women with early ovarian cancer
  15. Fertility in BRCA mutation carriers: counseling BRCA-mutated patients on reproductive issues
  16. Fertility preservation in borderline ovarian tumor patients and survivors
  17. Regular Issue
  18. Original Articles
  19. Effects of iron-related compounds and bilirubin on redox homeostasis in endometriosis and its malignant transformations
  20. miR-515-3p, miR-623, miR-1272 and Notch3 protein as new biomarkers of Hepatocellular carcinoma
  21. Combination therapy of calcitriol inhibits the proliferation of breast cancer cells: new concept of nonclassical function of calcitriol
  22. The change pattern in serum G protein-coupled estrogen receptor-1 (GPER1) levels during pregnancy with and without gestational diabetes mellitus
  23. Effects of Helichrysum Psudoplicatum supplementation on pruritus intensity, fatigue, quality of life and anorexia in hemodialysis patients: a randomized, double-blind placebo-controlled trial
  24. The anticancer and free radical scavenging potential of the Unani medicine Agaricus albus L.
  25. Review Articles
  26. What is the optimal luteal support in assisted reproductive technology?
  27. The relation between obesity, kisspeptin, leptin, and male fertility
https://doi.org/10.1515/hmbci-2020-0066
Keywords for this article
diaphragm; endometriosis; laparoscopy; robotics; thoracic syndrome

Articles in the same Issue

  1. Frontmatter
  2. Special Issue 1: Adenomyosis and Endometriosis: An Update; Edited by René Druckmann and Adolf E. Schindler
  3. Review Articles
  4. The impact of endometriosis on the outcome of assisted reproductive techniques: role of fertility preservation
  5. A narrative review of functional outcomes following nerve-sparing surgery for deeply infiltrating endometriosis
  6. Appropriate surgical management of ovarian endometrioma: excision or drainage?
  7. Diaphragmatic endometriosis and thoracic endometriosis syndrome: a review on diagnosis and treatment
  8. Rates of anastomotic leak and fistula following surgical management of bowel endometriosis: a comparison of shaving, discoid excision, and segmental resection
  9. Endometriosis at all ages: diagnostic ultrasound
  10. Special Issue 2: Fertility Preservation in Cancer Patients and Survivors; Edited by René Druckmann and Adolf E. Schindler
  11. Opinion Paper
  12. Quality of life and sexual dysfunction in gynaecological cancer patients: a psychosomatic approach
  13. Review Articles
  14. Fertility preservation in women with early ovarian cancer
  15. Fertility in BRCA mutation carriers: counseling BRCA-mutated patients on reproductive issues
  16. Fertility preservation in borderline ovarian tumor patients and survivors
  17. Regular Issue
  18. Original Articles
  19. Effects of iron-related compounds and bilirubin on redox homeostasis in endometriosis and its malignant transformations
  20. miR-515-3p, miR-623, miR-1272 and Notch3 protein as new biomarkers of Hepatocellular carcinoma
  21. Combination therapy of calcitriol inhibits the proliferation of breast cancer cells: new concept of nonclassical function of calcitriol
  22. The change pattern in serum G protein-coupled estrogen receptor-1 (GPER1) levels during pregnancy with and without gestational diabetes mellitus
  23. Effects of Helichrysum Psudoplicatum supplementation on pruritus intensity, fatigue, quality of life and anorexia in hemodialysis patients: a randomized, double-blind placebo-controlled trial
  24. The anticancer and free radical scavenging potential of the Unani medicine Agaricus albus L.
  25. Review Articles
  26. What is the optimal luteal support in assisted reproductive technology?
  27. The relation between obesity, kisspeptin, leptin, and male fertility
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