Thoracic endometriosis syndrome: Cutting the gordian knot – A case report and review of the literature

Highlights • Thoracic Endometriosis Syndrome is a rare disorder. • A strong relationship exists between thoracic endometriosis, pelvic endometriosis and infertility. • Diagnosis remains a challenge particularly in low resource settings. • Video-Assisted Thoracoscopic Surgery (VATS) remains the treatment of choice.
Introduction Thoracic Endometriosis Syndrome (TES) is a rare disorder characterized by the presence of functional endometrial tissue in the thoracic cavity, often associated with the visceral or parietal pleura, lung parenchyma or airways. The aim of this case report is to illustrate the classic manner of presentation of TES and the modalities of therapy employed in a low-resource setting in the South-Western region of Nigeria. Case presentation We report the case of a 37-year old woman who presented with right-sided pleuritic chest pain, cough and dyspnea closely associated with her menstrual cycle. On examination, there were reduced breath sounds and decreased air entry on the right hemithorax as well as dull percussion notes on the right middle and lower lung zones. Chest X-ray revealed signs of right-sided pleural effusion. Working diagnosis of right-sided Catamenial Pneumothorax was made for which she had 3 sessions of chemical pleurodesis which failed to close the air leaks. She eventually has a right-sided posterolateral thoracotomy and was co-managed by the O&G team with monthly Goserelin injections. Conclusion This case illustrates the difficulties physicians in low-resource settings face in the diagnosis and treatment of TES and the importance of a high index of suspicion as well as a multidisciplinary approach in patient care.