article · Case Reports in Radiology
Thoracic endometriosis syndrome (TES) is a rare condition where endometrial tissue grows in the chest cavity, affecting women of reproductive age. Its symptoms, such as chest pain and coughing blood, often mimic pulmonary tuberculosis (PTB), leading to misdiagnosis. A key diagnostic indicator is the cyclical nature of symptoms, which align with the menstrual cycle. This case report describes a 34-year-old businesswoman who experienced recurrent pelvic pain, heavy periods, and chest symptoms, including coughing blood, for several years. She was repeatedly treated for pneumonia and PTB without success. The cyclical pattern of her symptoms eventually led to a suspicion of TES, confirmed by investigations showing pelvic endometriomas and elevated CA-125, while PTB tests were negative. Hormonal suppression was initiated as the main treatment.
Recognising thoracic endometriosis syndrome is vital because its symptoms can be mistaken for more common conditions like pulmonary tuberculosis. Correct diagnosis prevents prolonged ineffective treatments, reduces patient suffering, and ensures appropriate management for this rare but impactful condition.
This abstract describes a clinical case of a rare condition and highlights diagnostic challenges. It does not indicate an application pathway for new products, services, or technologies, nor does it discuss any commercialisation potential.
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Background: Thoracic endometriosis syndrome (TES) is a rare form of endometriosis characterized by the presence of functioning endometrial tissue in the thoracic cavity. Patients are women of reproductive age, with a genetic link as a significant risk factor. Patients present with long‐standing chest symptoms and signs that mimic pulmonary tuberculosis (PTB). The crucial issue for establishing the diagnosis is the cyclicity of signs and symptoms which occur along with the menstrual cycle. Clinical Case: A 34‐year‐old businesswoman had recurrent pelvic pain and heavy menses for 6 years, recurrent chest pain for 5 years, and recently coughing blood for 3 days. Symptoms peaked during menstruation. She reported a maternal grandmother with similar symptomatology. For the past 6 years, she was treated for recurrent pneumonia and PTB without improvement. Examination revealed right‐sided pleural effusion and generalized pelvic tenderness. The catamenial nature of her symptoms led to a suspicion of TES, with PTB. Pleural fluid analysis showed exudative effusion, and Gene X‐pert for MTB was negative. CA‐125 was elevated, a nonspecific endometriosis marker. Pelvic ultrasound revealed features of pelvic endometriomas. Serial chest X‐ray and CT scan showed right hydropneumothorax, lung mass, lung collapse, and pulmonary fibrosis. Multiple chest tubes were placed for the recurrent hydropneumothorax management. Exploratory laparotomy with bilateral ovarian cystectomy was done, and histology revealed ovarian hemorrhagic cysts and salpingitis. Hormonal suppression initiated as mainstay of treatment. She is monitored monthly as an outpatient to assess treatment efficacy and condition progression. Conclusion/Learning Points: TES is a form of endometriosis involving the thoracic cavity, affecting women of reproductive age. TES may mimic PTB but symptoms correlate with the menstrual cycle (catamenial in nature). In Tanzania, diagnostic challenges persist due to its nonspecific symptoms, inadequate clinicians’ awareness, and lack of treatment guideline national wide.
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DOI: 10.1155/crra/1708094
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