Thoracic Endometriosis: Beyond the Pelvis in Diagnosis

[Dr. Shanti Mohling]
Yes, right. That's the biggest question. In a way, I suspect it in everyone. Just, I think it's more prevalent than we realize, although the numbers are that it's going to be up to 12% of people with invasive endometriosis, advanced endometriosis, that are also going to have extra pelvic disease. When I am meeting with someone, and we are pretty sure from their history, from their exam, from their family history, or from prior surgical documentation that they have endometriosis, and they want to have surgery and they want to have either just excision or they want to have excision with hysterectomy, very rarely, but occasionally, also oophorectomy, especially if they're over 50 and have involvement of the ovaries, I'm going to say, "Listen, some of my patients have diaphragmatic disease."

We have a conversation. "One, do you have symptoms? Do you have chest pain? Do you have shoulder pain? Do you have, or if anyone has a history of catamenial, meaning with the menstrual cycle, pneumothorax, or symptoms?" I'm going to have an increased threshold of interest that they might have diaphragmatic or thoracic disease. I start out, before we even go to surgery, I counsel them that I always look, and if I find it, do they want me to remove it?