With expert input from Dr. Christopher Kliethermes, Gynecologic Surgeon at PRM’s Center of Excellence in Troy
Endometriosis is often thought of as a condition affecting the pelvic region, but in some cases, it can extend beyond the reproductive organs and impact other parts of the body. One of the less commonly discussed forms is thoracic endometriosis, which occurs when endometriosis lesions develop in the upper abdomen, including the diaphragm, lung space, or even near the heart.
While this condition is estimated to affect 1 to 2 percent of endometriosis patients, this number may actually be underestimated due to limited diagnostic awareness and surgical evaluation by non-specialists or general OB/GYN surgeons.
Why Is Thoracic Endometriosis Hard to Diagnose?
One of the reasons thoracic endometriosis can be challenging to diagnose is the way inflammation spreads in the body. Within the abdominal cavity, inflammation from endometriosis lesions tends to move in a clockwise direction, meaning that when the pelvic area is inflamed, the irritation and disease can travel upward to the upper right abdomen. This can lead to symptoms that mimic other conditions, making diagnosis even more difficult.
Symptoms of Thoracic Endometriosis
Symptoms of thoracic endometriosis can vary, but some of the most common include:
- Difficulty breathing
- Rib pain
- Muscle pain in the upper abdomen
- Chest pain that worsens with the menstrual cycle
More obvious signs of thoracic endometriosis include:
- Catamenial pneumothorax – recurring lung collapse that occurs in sync with the menstrual cycle
- Hemoptysis – coughing up blood during menstruation
If you experience these symptoms, particularly if they worsen around your period, it is crucial to consult an experienced endometriosis specialist who understands how to evaluate and treat thoracic involvement.
Surgical Treatment for Thoracic Endometriosis
Because thoracic endometriosis can extend beyond the diaphragm and into the pleural space (the area surrounding the lungs), surgery for this condition requires a highly skilled team.
A specialized endometriosis excision surgeon should be able to safely remove endometriosis from the diaphragm. However, in cases where the disease has deeply invaded the diaphragm, a diaphragmatic resection (partial or full removal of the affected diaphragm muscle) may be necessary.
In severe cases, where endometriosis has spread into the thoracic cavity, it is vital for the excision surgeon to collaborate with a skilled cardiothoracic surgeon. This partnership ensures that the complex thoracic symptoms, such as hemoptysis or recurrent pneumothorax, are properly addressed and that the patient receives comprehensive surgical care.
Why Choosing the Right Surgeon Matters
Thoracic endometriosis is a complex and often overlooked condition, but it can be effectively treated when handled by the right specialists. If you suspect you may have thoracic endometriosis, make sure your surgeon is comfortable evaluating and excising endometriosis from the upper abdomen and diaphragm. Additionally, for more advanced cases involving the lungs or pleural space, seek care from a surgical team that includes a cardiothoracic expert familiar with endometriosis.
With the right team and approach, thoracic endometriosis can be treated successfully, leading to significant symptom relief and an improved quality of life.
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