Background. Thoracic endometriosis is thought to be the most common form of endometriosis occurring outside of the pelvis. We aimed to characterize thoracic symptoms of endometriosis in a population of patients not necessarily suffering from catamenial pneumothorax, which is most commonly identified as a symptom of thoracic endometriosis. Material and methods. We used a web-based survey addressed to users of two Polish endometriosis patient advocate organizations. The factor that qualified patients for the study was the presence of symptoms in the chest related to the menstrual cycle. Results. A total of 92 respondents were questioned. In this group, 96% (88/92) of patients were previously diagnosed with pelvic endometriosis, 20% (18/92) with thoracic endometriosis, and 18% (17/92) with diaphragmatic endometriosis. The percentage of patients diagnosed with both thoracic and diaphragmatic endometriosis was 15% (14/92). Ninety-eight percent of patients suffered from pain. The four most common symptoms reported by patients were chest pain, dyspnea, cough, and stunned limb, occurring in 96%, 67%, 52%, and 33%, respectively. The feeling of a stunned, weakened limb occurs in older women at 38.4 vs. 35.5 years of age (p = 0.021). There is a trend that women who suffer pain (36.7 vs. 31.3 years of age p = 0.053) and hemoptysis (41.0 vs. 36.2 years of age p = 0.059) are older than women without these symptoms. We identified two unique symptoms of thoracic endometriosis—pouring liquid sensation (13%) and popping sensation (12%)—which can be related to a small amount of gas and fluid in the pleural cavity. Conclusions. Patients who have endometriosis suffer from a constellation of thoracic symptoms related to menses.

Thoracic endometriosis syndrome (TES) is the most common extrapelvic manifestation of endometriosis, yet its classification, diagnosis, and treatment remain debated. Thoracic endometriosis syndrome has recently been proposed to be categorized into 3 types: pleural, bronchopulmonary, and diaphragmatic. Our study aims to propose a 3-step approach - computed tomography (CT) imaging, careful intraoperative assessment, and targeted pathology - to enhance the diagnostic process and optimize the management of TES-related pneumothorax. We retrospectively analyzed 3 cases of recurrent right-sided catamenial pneumothorax in female patients with a history of pelvic endometriosis, managed surgically at the Department of Thoracic Surgery, Medical University of Gdansk, between 2021 and 2024. All included patients underwent video-assisted thoracoscopic surgery (VATS), with comprehensive preoperative CT imaging, intraoperative lesion mapping, and postoperative histopathological examination, improving diagnostic accuracy in TES, with a possible impact on therapeutic results. Chest CT is essential for detecting bullous lesions, aiding in intraoperative identification and surgical treatment. Immunohistochemistry (IHC), assessing estrogen receptor (ER) and CD10 for stromal identification, improves pathological accuracy. This study underlines the diagnostic value of integrating imaging, intraoperative assessment, and targeted histopathology, as well as clear communication between surgeons, radiologists, and pathologists to ensure accurate diagnosis and an improved therapeutic process for patients in clinical practice.