Ann Thorac Surg 2006;81:373
© 2006 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Magnetic Resonance Images of Diaphragmatic Endometriosis Treated by Polyglactin Mesh
Patrick Bagan, MD
a
,
c
,
*
,
Francoise Le Pimpec-Barthes, MD
c
,
Emmanuel Martinod, MD
a
,
Michel Brauner, MD, PhD
b
,
Jacques F. Azorin, MD
a
,
Marc Riquet, MD, PhD
c
a Department of Thoracic and Vascular Surgery, Avicenne Hospital, Paris XIII University, Bobigny, France
b Department of Radiology, Avicenne Hospital, Paris XIII University, Bobigny
c Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris V University, Paris, France
* Address correspondence to Dr Bagan, Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, 20-40 Rue Leblanc, 75908 Paris, France (Email: pbagan{at}mageos.com).
Catamenial pneumothorax is associated with a high rate of postoperative recurrence, probably because of unobserved diaphragmatic lesions. In a previous report, we proposed to perform surgical treatment during menstruation for an optimal visualization of pleurodiaphragmatic endometriosis [1]. We also suggested the systematic coverage of the tendinous portion of the diaphragm by a polyglactin mesh. The goal of mesh insertion was to induce fibrosis and to contain and prevent diaphragmatic perforation by endometrial implants.
We present the case of a 37-year-old woman who underwent thoracoscopy in April 2002 for a right-side recurrent pneumothorax. On thoracoscopic examination performed during menstruation, we observed diaphragmatic defects and endometriosis confirmed pathologically (Fig 1). A polyglactin mesh (Vicryl; Ethicon, Inc, Somerville, NJ) was inserted on the diaphragmatic surface after pleural abrasion (Fig 2). After a 14-month follow-up, the patient experienced no recurrence of pneumothorax, without hormonal treatment.
T2 magnetic resonance images, performed 1 year after operation and 10 days after menstruation, showed hypersignal only on the tendinous part of right hemidiaphragm, which seemed to correspond with fibrosis (Fig 3; the arrow shows the hypersignal on the tendinous part of the right hemidiaphragm). This observation confirms our hypothesis that polyglactin mesh reinforces the diaphragmatic surface and helps to prevent recurrence.
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References
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- Bagan P, Le Pimpec Barthes F, Assouad J, Souilamas R, Riquet M. Catamenial pneumothoraxretrospective study of surgical treatment. Ann Thorac Surg 2003;75:378-381.[Abstract/Free Full Text]
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