Highlights Thoracic Endometriosis Case

Treatment of a very difficult case of catamenial pneumothorax, a form of endometriosis that passes the diaphragm and enters the chest cavity.

Key Points

Highlights:

• New York Times recently published an article on diagnosing and treating a case of a collapsed lung that was linked to endometriosis by Dr. Tamer Seckin, the founder of the Endometriosis Foundation of America.

Importance:

• Endometriosis can manifest in various ways and publish the less common cases will spread awareness of the disease variety. Then health care providers, patients, and families of patients will know what to look for in unusual cases of endometriosis.

What’s done here?

• This New York Times article illuminates one woman’s rather unusual and lengthy journey to a diagnosis of endometriosis.

Key points:

• A patient with a collapsed right lung was seen by a doctor after she felt a click, a sudden movement, developed a cough, and then had difficulty walking. The doctor diagnosed her with spontaneous pneumothorax because she did not exhibit the risk factors for pneumothorax.
• A year later, the patient’s lung collapsed again and Dr.Patton recommended pleurodesis, a procedure that ensures the lung will not collapse in the case of a leak. Yet, the lung continued to exhibit abnormalities and developed a leak again.
• The patient thought the symptoms were a consequence of her past IVF treatments, but there were no links between the two.
• There was a link between the pneumothorax and endometriosis. Endometriosis cells can move past the diaphragm and settle into the chest. This is called a "catamenial pneumothorax".
• Despite taking hormonal pills, the patient had a collapsed lung. She went to the hospital and was treated by Dr. Seckin. He found endometrial implants in her body but not on the diaphragm. Pathological evaluation of tissue revealed endometriosis on the diaphragm.
• The patient underwent a second operation where Dr. Seckin removed all visible endometriosis implants, ovaries, and uterus.
• The patient is slowly recovering and regaining quality of life.

Lay Summary

Dr. Tamer Seckin, MD, the co-founder of the Endometriosis Foundation of America, was recently featured in a New York Times article titled “The Woman Was Fit and Healthy. Why Did Her Lung Mysteriously Collapse?” The article describes a rather unusual and rare case of endometriosis that presents with a collapsed lung.

The patient had a collapsed lung that was initially diagnosed as spontaneous pneumothorax; however, her lungs collapsed multiple times after the initial incident disproving the first diagnosis. The patient underwent a pleurodesis, a procedure that physically restricts the lung from collapsing even in the event of a leak, upon the recommendation of Dr. Byron Patton. Yet the patient continued to experience abnormal lung behavior.

Eventually, the doctor found a leak in her lung. Then her lung completely collapsed. The patient had begun reading about catamenial pneumothorax, a form of pneumothorax caused by endometriosis.

The endometriosis cells can move past the diaphragm and settle in the chest. The patient was then observed by Dr. Seckin; he and Dr. Patton conducted a joint surgery.

Dr. Seckin found various endometrial implants. Tissue from the diaphragm was pathologically confirmed to be endometriosis. The patient underwent a second surgery where Dr. Seckin removed the implants, ovaries, and uterus.

The patient is recovering and regaining her quality of life.