DOI: 10.12890/2026_007519
Recurrent catamenial hemopneumothorax caused by diaphragmatic endometriosis not identified by chest X-ray or CT scan: a case report and literature review
Authors
macthetruong@hmu.edu.vn
Keywords
Thoracic endometriosis syndrome, diaphragmatic endometriosis, catamenial hemopneumothorax, video-assisted thoracoscopic surgeryAbstract
Introduction: Thoracic endometriosis syndrome (TES) is a rare extrapelvic manifestation of endometriosis. Catamenial hemopneumothorax secondary to diaphragmatic endometriosis is particularly uncommon and remains a diagnostic challenge because of its nonspecific clinical and radiological findings. Early recognition of the temporal relationship between thoracic symptoms and menstruation is essential for timely diagnosis and management.
Case description: A 44-year-old woman presented with recurrent right-sided hemopneumothorax occurring within 72 hours of menstruation onset. Chest radiography and computed tomography demonstrated right pleural effusion and pneumothorax but failed to identify the underlying cause. Because of recurrence, video-assisted thoracoscopic surgery (VATS) was performed. Intraoperative findings included approximately 500 ml of old blood in the pleural cavity, multiple dark-red nodules on the right hemidiaphragm, and a 1-cm diaphragmatic defect. The affected diaphragmatic tissue was resected using an endoscopic stapler, followed by diaphragmatic repair and pleurodesis. Histopathological examination confirmed diaphragmatic endometriosis. The postoperative course was uneventful, and no recurrence was observed during a 3-month follow-up period.
Conclusion: Diaphragmatic endometriosis should be considered in women of reproductive age presenting with recurrent hemopneumothorax, particularly when episodes coincide with menstruation. VATS plays a pivotal role in both diagnosis and treatment by enabling direct visualization of diaphragmatic lesions, definitive histopathological confirmation, and simultaneous surgical management.
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