Thoracic endometriosis: imaging perspectives in diagnosis

Thoracic endometriosis is an uncommon but likely underrecognized manifestation of extragenital endometriosis that can present with catamenial pneumothorax, chest pain, and respiratory symptoms. This case series reviews imaging findings from three patients (aged 27 to 38) with histologically confirmed thoracic endometriosis. Imaging modalities included chest radiographs and contrast-enhanced magnetic resonance imaging. Key findings included pleural nodules, recurrent right-sided pleural effusions, pneumothoraces, and diaphragmatic involvement, often correlating with menstrual cycles. Recognizing these imaging features is essential for accurate diagnosis, as thoracic endometriosis can mimic other pulmonary conditions. Radiologists and clinicians should maintain a high index of suspicion in reproductive-age women with cyclic thoracic symptoms.