The relevance of menstrual timing for surgery of thoracic endometriosis

Thoracic endometriosis is a rare disorder characterized by deposits of functioning endometrial tissue in thoracic organs that primarily affects women of reproductive age. Depending on the localization of the endometriosis foci, it may appear as spontaneous pneumothorax, by far the most common presentation, pulmonary nodules or hemothorax (seldom), or hemoptysis, when implants develop in the tracheobronchial tree (extremely rare). Diagnosis of this entity is almost always delayed due to its rare occurrence and its nonspecific clinical and radiological signs, thus diagnosis requires a high index of suspicion based on the co-occurrence of episodes and menstrual bleeding. This is a report of an unusual case of pleuropulmonary and endotracheal endometriosis that presented with recurrent hemothorax. Minimally invasive surgery scheduled for the days of menstruation played a major role in its diagnosis and management.