Diagnostic Challenges and Innovations in Thoracic Endometriosis (TE)
Exploring the Role of Imaging and Biomarkers. A narrative review
DOI:
https://doi.org/10.12775/QS.2025.37.57087Keywords
thoracic endometriosis, endometriosis, diagnosis, imaging, biomarkersAbstract
Endometriosis is a condition characterized by the presence of endometrial tissue in ectopic locations outside the gynecological organs. Thoracic endometriosis (TE) is a rare and underdiagnosed condition characterized by the presence of endometrial-like tissue in the thoracic cavity, leading to cyclical respiratory symptoms. TE is often misdiagnosed or overlooked, primarily due to its nonspecific symptoms. Advancements in imaging techniques and biomarkers research are promising in improving the diagnosis of TE. High-resolution imaging modalities, such as high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI), provide detailed visualization of pleural and pulmonary lesions and leverage hormonal responsiveness for dynamic imaging during the menstrual cycle. The identification of novel biomarkers, such as cystatin C and circulating microRNAs, highlights the potential for non-invasive diagnostic tools that can stratify patients based on disease severity and guide personalized treatment strategies. Early diagnosis and treatment of thoracic endometriosis are crucial to prevent severe complications such as recurrent pneumothorax, pleural adhesions, and progressive lung damage. Timely intervention also reduces the burden of chronic pain and improves quality of life, enabling more effective management of this underdiagnosed condition. The aim of this paper is to explore current diagnostic possibilities for TE, particularly through the lens of advanced diagnostic innovations, and assess their potential to improve outcomes for patients with this complex condition.
References
Nezhat C, Lindheim SR, Backhus L, et al. Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management. JSLS. 2019;23(3):e2019.00029. doi:10.4293/JSLS.2019.00029
Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: A review. Reprod Med Biol. 2020;19(4):323-333. Published 2020 Jul 16. doi:10.1002/rmb2.12340
Jubanyik KJ, Comite F. Extrapelvic endometriosis. Obstet Gynecol Clin North Am. 1997;24(2):411-440. doi:10.1016/s0889-8545(05)70311-9
El-Zibdeh A, Arambage K, et al. The Continuous Textbook of Women’s Medicine Series Gynecology Module Volume 3 ENDOMETRIOSIS. Glob. libr. women's med. 2024; ISSN: 1756-2228. doi: 10.3843/GLOWM.417723.
Joseph J, Sahn SA. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med. 1996;100(2):164-170. doi:10.1016/s0002-9343(97)89454-5
Joseph J, Reed CE, Sahn SA. Thoracic endometriosis. Recurrence following hysterectomy with bilateral salpingo-oophorectomy and successful treatment with talc pleurodesis. Chest. 1994;106(6):1894-1896. doi:10.1378/chest.106.6.1894
Alifano M, Roth T, Broët SC, Schussler O, Magdeleinat P, Regnard JF. Catamenial pneumothorax: a prospective study. Chest. 2003;124(3):1004-1008. doi:10.1378/chest.124.3.1004
Kovarik JL, Toll GD. Thoracic endometriosis with recurrent spontaneous pneumothorax. JAMA. 1966;196(6):595-597.
Sampson JA. The development of the implantation theory for the origin of peritoneal endometriosis. Am J Obstet Gynecol. 1940;40:549-57.
Alifano M, Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge. Ann Thorac Surg. 2006;81(2):761-769. doi:10.1016/j.athoracsur.2005.07.044
Korom S, Canyurt H, Missbach A, et al. Catamenial pneumothorax revisited: clinical approach and systematic review of the literature. J Thorac Cardiovasc Surg. 2004;128(4):502-508. doi:10.1016/j.jtcvs.2004.04.039
Bagan P, Le Pimpec Barthes F, Assouad J, Souilamas R, Riquet M. Catamenial pneumothorax: retrospective study of surgical treatment. Ann Thorac Surg. 2003;75(2):378-381. doi:10.1016/s0003-4975(02)04320-5
JAVERT CT. Observations on the pathology and spread of endometriosis based on the theory of benign metastasis. Am J Obstet Gynecol. 1951;62(3):477-487. doi:10.1016/0002-9378(51)91147-7
Augoulea A, Lambrinoudaki I, Christodoulakos G. Thoracic endometriosis syndrome. Respiration. 2008;75(1):113-119. doi:10.1159/000105102
Channabasavaiah AD, Joseph JV. Thoracic endometriosis: revisiting the association between clinical presentation and thoracic pathology based on thoracoscopic findings in 110 patients. Medicine (Baltimore). 2010;89(3):183-188. doi:10.1097/MD.0b013e3181df67d5
Johnson MM. Catamenial pneumothorax and other thoracic manifestations of endometriosis. Clin Chest Med. 2004;25(2):311-319. doi:10.1016/j.ccm.2004.01.005
Saglam M, Balkan A, Tasar M, Balkan M, Bozlar U, Kocaoglu M. Pulmonary endometriosis: diagnosis with computed tomography and high resolution computed tomography (HRCT). Eur J Radiol Extra. 2005;56(1):25-28.
Bahall V, De Barry L, Harry SS, Bobb M. Gross Ascites Secondary to Endometriosis: A Rare Presentation in Pre-Menopausal Women. Cureus. 2021;13(8):e17048. Published 2021 Aug 10. doi:10.7759/cureus.17048
Bahall V, De Barry L, Singh K. Thoracic endometriosis masquerading as Meigs' syndrome in a young woman: A case report and literature review. Case Rep Womens Health. 2022;36:e00452. Published 2022 Oct 4. doi:10.1016/j.crwh.2022.e00452
Orriols R, Muñoz X, Alvarez A, Sampol G. Chest CT scanning: utility in lung endometriosis. Respir Med. 1998;92(6):876-877. doi:10.1016/s0954-6111(98)90392-4
Rousset P, Rousset-Jablonski C, Alifano M, Mansuet-Lupo A, Buy JN, Revel MP. Thoracic endometriosis syndrome: CT and MRI features. Clin Radiol. 2014;69(3):323-330. doi:10.1016/j.crad.2013.10.014
Marchiori E, Zanetti G, Rodrigues RS, et al. Pleural endometriosis: findings on magnetic resonance imaging. J Bras Pneumol. 2012;38(6):797-802. doi:10.1590/s1806-37132012000600017
Velagapudi RK, Egan JP. Thoracic endometriosis: a clinical review and update of current and evolving diagnostic and therapeutic techniques. Curr Pulmonol Rep. 2021;10:22-29. doi:10.1007/s13665-021-00269-z.
Nezhat C, Nezhat F, Nezhat C. Nezhat’s Video-Assisted and Robotic-Assisted Laparoscopy and Hysteroscopy with DVD. 3rd ed. New York: Cambridge University Press; 2013.
Inoue T, Kurokawa Y, Kaiwa Y, et al. Video-assisted thoracoscopic surgery for catamenial hemoptysis. Chest. 2001;120(2):655-658. doi:10.1378/chest.120.2.655
Saglam M, Balkan A, Tasar M, Balkan M, Bozlar U, Kocaoglu M. Pulmonary endometriosis: Diagnosis with computed tomography and high resolution computed tomography (HRCT). Eur J Radiol Extra. 2005;56(1):25-28. doi:10.1016/j.ejrex.2005.07.014.
Swensen SJ. Focal lung disease: CT and high-resolution CT applications. Radiographics. 1994;14(1):169-184. doi:10.1148/radiographics.14.1.8128049
Bourgioti C, Preza O, Panourgias E, et al. MR imaging of endometriosis: Spectrum of disease. Diagn Interv Imaging. 2017;98(11):751-767. doi:10.1016/j.diii.2017.05.009
Botterill EM, Esler SJ, McIlwaine KT, et al. Endometriosis: Does the menstrual cycle affect magnetic resonance (MR) imaging evaluation?. Eur J Radiol. 2015;84(11):2071-2079. doi:10.1016/j.ejrad.2015.08.003
Rousset P, Gregory J, Rousset-Jablonski C, et al. MR diagnosis of diaphragmatic endometriosis. Eur Radiol. 2016;26(11):3968-3977. doi:10.1007/s00330-016-4226-5
Zhang M, Cheng S, Jin Y, Zhao Y, Wang Y. Roles of CA125 in diagnosis, prediction, and oncogenesis of ovarian cancer. Biochim Biophys Acta Rev Cancer. 2021;1875(2):188503. doi:10.1016/j.bbcan.2021.188503
Bagan P, Berna P, Assouad J, Hupertan V, Le Pimpec Barthes F, Riquet M. Value of cancer antigen 125 for diagnosis of pleural endometriosis in females with recurrent pneumothorax. Eur Respir J. 2008;31(1):140-142. doi:10.1183/09031936.00094206
Thubert T, Santulli P, Marcellin L, et al. Measurement of hs-CRP is irrelevant to diagnose and stage endometriosis: prospective study of 834 patients. Am J Obstet Gynecol. 2014;210(6):533.e1-533.e10. doi:10.1016/j.ajog.2014.01.022
Kılıçkıran H, Halilzade İ, Halilzade Mİ, Topçuoğlu C, Çınar M. Role of cystatin C levels as an inflammatory marker in predicting endometriosis. Rev Assoc Med Bras (1992). 2023;69(12):e20230613. Published 2023 Nov 24. doi:10.1590/1806-9282.20230613
Hon JX, Wahab NA, Karim AKA, Mokhtar NM, Mokhtar MH. MicroRNAs in Endometriosis: Insights into Inflammation and Progesterone Resistance. Int J Mol Sci. 2023;24(19):15001. Published 2023 Oct 9. doi:10.3390/ijms241915001
Burney RO, Hamilton AE, Aghajanova L, Vo KC, Nezhat CN, Lessey BA, et al. MicroRNA expression profiling of eutopic secretory endometrium in women with versus without endometriosis. Mol Hum Reprod 2009;15: 625–31.
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Copyright (c) 2025 Julia Bałoniak, Zofia Szymańska, Agnieszka Leszyńska , Zuzanna Bałoniak, Aleksandra Jonkisz , Gabriela Skurzyńska , Aleksandra Stremel, Michalina Doligalska
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