Shadows of the Cycle: A Case Report on Thoracic Endometriosis

Genital / Reproductive system female, Thorax, CT-High Resolution, Digital radiography, PACS, Computer Applications-3D, Diagnostic procedure, Surgery, Education and training, Other Authors: K. A. Carcel DOI: 10.26044/ranzcr2026/C-114 Learning objectives To review the spectrum of imaging findings associated with thoracic endometriosis syndrome (TES) To highlight key radiologic features that raise suspicion for catamenial pneumothorax and TES in women with reproductive age To emphasize the role of multimodality imaging in raising diagnostic suspicion and facilitating multidisciplinary management of TES

Endometriosis affects approximately 10% of women of reproductive age and is characterized by the presence of functional endometrial tissue outside the uterine cavity. While predominantly pelvic, ectopic endometriosis may involve the diaphragm, pleura, or lung parenchyma, giving rise to a spectrum of thoracic manifestations. These include catamenial pneumothorax, hemothorax, hemoptysis, and pulmonary nodules, collectively termed thoracic endometriosis syndrome (TES). Owing to its variable clinical and imaging appearances, TES remains a diagnostic challenge and a recognized radiologic pitfall, particularly when the temporal association with the menstrual... Imaging findings OR Procedure details PROFILEWe describe a rare case of a 46-year-old woman with a history of one spontaneosly delivered IVF pregnancy, who presented to the emergency room (ER) with back pain and dyspnea on exertion and alleviated by rest. She has an 18-year history of pelvic endometriosis and had endometrial implants removed laparoscopically.Despite surgery, she continued to experience cyclic pelvic pain. Notably, her menstrual cycles were accompanied by mild, intermittent dyspnea demonstrating a catamenial association, which she did not initially perceive as clinically significant. She was subsequently lost...

Thoracic endometriosis syndrome is a rare, recurrent and frequently underdiagnosed manifestation of endometriosis. This case highlights the critical role of imaging in recognizing thoracic endometriosis, underscores key radiologic clues that aid in diagnosis, and emphasizes the importance of maintaining a high index of suspicion in women with recurrent thoracic symptoms and a known history of endometriosis.

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