Authors: Yamal Patel , Kennedy Malele , Joseph Santeto , Alin Constantin , Joseph Njagi , Charles Muriuki

Abstract

Background: Diaphragmatic endometriosis (DE) is a rare and often underdiagnosed type of extrapelvic endometriosis. It usually presents with atypical cyclical symptoms of thoracic involvement.

Case Presentations: We present three African women with pelvic endometriosis and thoracic symptoms. The first case involved a 32-year-old nulligravida who presented with dysmenorrhea, cyclical hemoptysis, pleural effusions, and subfertility. An MRI showed a right pleural effusion and associated diaphragmatic lesions. Laparoscopic excision provided a diagnosis of DE, and she improved with postoperative treatment of dienogest (Endogest: 2 mg). The second case was a 33-year-old woman with recurrent cyclical dyspnea and right chest pain with a history of pelvic endometriosis. She was urgently admitted and underwent VATS surgery and subsequent pleurodesis. She was treated successfully with a GnRH agonist (11.25mg) and stabilized on this treatment. The third case was a 29-year-old nullipara who presented with cyclical right chest pain. An MRI demonstrated a right diaphragmatic nodule which was excised laparoscopically. Histology confirmed DE in all the cases.

Outcomes: All three patients achieved significant thoracic symptoms relief after surgery and hormonal suppression.

Conclusion: This case series outlines the clinical diversity of DE and strengthens the rationale for considering cyclical thoracic symptoms in female patients with pelvic disease. Imaging studies are supportive of diagnosis, but surgical confirmation and histology remain crucial. Long-term follow-up and multidisciplinary care are necessary to limit recurrence and ensure favorable outcomes.

Keywords: Diaphragmatic endometriosis; pelvic endometriosis, VATS; hemidiaphragm; laparoscopy; case series.