Endometriosis is a common gynecologic condition that has variable clinical findings. Typical signs and symptoms include dysmenorrhea, pelvic pain, and infertility. However, when endometrial deposits are located outside the pelvis, patients may present in a more unusual fashion. We report a case of extra-pelvic endometriosis that was identified following treatment for recurrent pneumothorax. A 28-year-old nulliparous female presented with recurrent pneumothorax associated with her menstrual cycle. Initial thoracoscopic surgery identified a suspicious apical bleb. Following its resection however, her symptoms persisted. Ovarian suppression using a GnRH-agonist resulted in significant symptomatic control. This prompted a second-look thoracoscopy with a gynecologist in attendance. A right diaphragmatic deposit of ectopic endometriosis was resected with resolution of the problem. We discuss current pathogenic theories of endometriosis and catamenial pneumothorax. Additionally, we review the spectrum of presentation, dilemma of diagnosis, and available therapies used in the treatment of endometrial-associated pneumothorax. We speculate on efficacy of novel therapies (e.g., dienogest) in the treatment of extrapelvic endometriosis. This case study demonstrates the benefit of empiric treatment with ovulation suppression when other diagnostic modalities proved inconclusive. Furthermore, it highlights the importance of interdisciplinary care and stresses the need for increased awareness of endometriosis in non-gynecologic specialties.

Authors: Kerry HOWATT, Kenneth REID, Robert L. REID

Key Words: Endometriosis; catamenial pneumothorax; thoracic endometriosis; menstrual suppression