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Master Thesis

Pneumothorax spontané de la femme en âge de procréer et endométriose thoracique

Abstract : BACKGROUND: In women of childbearing age, thoracic endometriosis (TE) is still an underdiagnosed etiology of spontaneous pneumothorax (SP). Catamenial pneumothorax (CP) is the most common mode of revelation. The main objective of this study was to study the prevalence of ET-related pneumothorax (PNO). METHODS: A retrospective mono-centric study was conducted by collecting epidemiological, clinical, radiological, macroscopic and pathological data in women of childbearing age (age 15-52 years) who had been referred and operated for the treatment of spontaneous pneumothorax at the Thoracic Surgery department of the Hôtel Dieu/Cochin hospital between June 1999 and December 2018. RESULTS: 384 women were included. The average age was 32 years old. The PNO was catamenial in 36% (n=137). CP were endometriosis related in 62% of cases (n=85), 22,1% of the whole population. Pneumothoraces were non catamenial but endometriosis related in 8% of cases (n=31) and idiopathic in 56,3% of patients (n=216). Macroscopic TE lesions were found in 116 patients (30%), with right-sided diaphragmatic defect as a predominant lesion. The histology of the diaphragmatic defect found 43,4% of endometrial glands, and 71,6% of endometrial stroma. Macroscopic lesions of ET were more noticeable in patients with a history of pelvic endometriosis (EP) 78.3% vs. 23% (p <0.001). The probability of conversion to thoracotomy was greater in catamenial pneumothorax than non-catamenial pneumothorax 41.6% vs 12.6% (p <0.001). In multivariate analysis, only the intraoperative presence of thoracic endometriotic lesions was an independent factor of postoperative recurrence. CONCLUSION: Thoracic endometriosis is a major etiology in women of childbearing with surgically treated pneumothorax. The optimal diagnosis and treatment management of these patients is multidisciplinary. It involves gynecologists, pulmonologists, thoracic surgeons, and anatomopathologists.
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Clément Lebreton. Pneumothorax spontané de la femme en âge de procréer et endométriose thoracique. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02352798⟩

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