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Obstetrics2271 papers

Endometriosis of pleura

Last edited: 4/16/2026

Overview

Endometriosis involving the pleura is an uncommon extrapelvic manifestation of endometriosis, characterized by the presence of endometrial-like tissue in the pleural cavity, often causing cyclic or chronic pleural pain and potentially pleural effusion. 3034

Diagnosis

  • Clinical Presentation: Cyclic or chronic pleural pain, dyspnea, and pleural effusion.
  • Imaging: Chest CT or MRI may reveal pleural thickening or nodules suggestive of endometriosis.
  • Diagnostic Procedures: Thoracoscopy or thoracentesis with histopathological examination is definitive for diagnosis.
  • Grading: Not typically applicable as specific grading systems for pleural endometriosis are lacking; clinical severity may guide management. 3034
  • Management

  • First-Line Treatments:
  • - Hormonal Therapy: Depot medroxyprogesterone acetate (DMPA) and GnRH agonists (e.g., leuprolide) for pain management. 2258 - Progestins: Including medroxyprogesterone acetate, which may be used for symptom relief. 122
  • Surgical Intervention:
  • - Thoracoscopic Resection: For definitive treatment of symptomatic pleural endometriosis. 30
  • Add-Back Therapy: Considered in prolonged GnRH agonist use to mitigate side effects like osteoporosis and mood changes. (Evidence: Moderate) 50
  • Special Populations

  • Pregnancy: Limited data; hormonal treatments may need adjustment or discontinuation during pregnancy. 27
  • Comorbidities: Management of comorbidities like hypertension (e.g., unilateral ureteral obstruction due to endometriosis) requires multidisciplinary care. 74
  • Key Recommendations

  • Use Thoracoscopy for Definitive Diagnosis and Treatment: When clinical suspicion is high, thoracoscopic evaluation is crucial for both diagnosis and surgical intervention. (Evidence: Moderate) 30
  • Consider Hormonal Therapy for Symptom Control: Depot medroxyprogesterone acetate and GnRH agonists are effective for managing pain associated with pleural endometriosis. (Evidence: Moderate) 2258
  • Evaluate for Add-Back Therapy in Long-Term Hormonal Management: To mitigate side effects of prolonged GnRH agonist therapy, incorporate add-back therapy with estrogen and progestin. (Evidence: Moderate) 50
  • References

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    Original source

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