The menstrual cycle behind recurrent pneumothorax: Lessons from reported cases of thoracic endometriosis

Title : The menstrual cycle behind recurrent pneumothorax: Lessons from reported cases of thoracic endometriosis

Abstract:

Background: Thoracic endometriosis syndrome (TES) is a rare extrapelvic manifestation of endometriosis that may present with recurrent pneumothorax, hemothorax, hemoptysis, or pulmonary lesions. Because symptoms often overlap with common thoracic conditions, diagnosis may be delayed unless their relationship with the menstrual cycle is recognized. Herein, we aim to define the clinical profile, diagnostic features, therapeutic strategies, and recurrence patterns of TES.

Methods: A systematic review of the literature was performed, including English-language case reports and case series published between January 1950 and August 2026. Data regarding symptoms, lesion location, imaging, pathological confirmation, prior gynecological history, treatment, and recurrence were extracted.

Results: Pneumothorax was the most common clinical manifestation, followed by chest pain, dyspnea, and hemoptysis. Thoracic lesions demonstrated a clear right-sided predominance, while chest CT emerged as the most useful imaging modality for lesion localization, commonly revealing ground-glass opacities, nodules, cystic lesions, and consolidation. Cyclic disappearance or reduction of thoracic lesions during the menstrual cycle represented an important diagnostic clue. Histopathological confirmation was obtained in a substantial proportion of cases, while others were diagnosed through characteristic clinical and radiological patterns. Video-assisted thoracoscopic surgery was the predominant surgical approach, frequently combined with hormonal therapy. Hormonal treatment alone was also used, although recurrence remained a relevant clinical issue across different treatment strategies.

Conclusions: TES should be considered in reproductive-age women with recurrent or cyclical thoracic symptoms, particularly right-sided pneumothorax. Recognition of menstrual timing, characteristic imaging patterns, and multidisciplinary collaboration between gynecologists, pulmonologists, radiologists, and thoracic surgeons are central to timely diagnosis and individualized management.

Biography:

Konstantinos Kontzoglou is Professor of Surgery at the National and Kapodistrian University of Athens and Director of the N.S. Christeas Laboratory of Experimental Surgery and Surgical Research. He is a surgeon in the Second Department of Propedeutic Surgery at Laiko General Hospital. He had advanced training in Molecular and Surgical Oncology in France and the USA. He has extensive teaching experience, including an academic appointment at Lanzhou University, China. His research work includes international collaborations, more than 200 peer-reviewed publications and more than 150 presentations in international and Greek conferences. He also serves as Cultural Attaché of the I.A.C.D.