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Magnetic Resonance Images of Diaphragmatic Endometriosis Treated by Polyglactin Mesh
IMAGES IN CARDIOTHORACIC SURGERY
Magnetic Resonance Images of Diaphragmatic Endometriosis Treated by Polyglactin Mesh Patrick Bagan, MD, Francoise Le Pimpec-Barthes, MD, Emmanuel Martinod, MD, Michel Brauner, MD, PhD, Jacques F. Azorin, MD, and Marc Riquet, MD, PhD
Fig 1.
FEATURE ARTICLES
Departments of Thoracic and Vascular Surgery, and Radiology, Avicenne Hospital, Paris XIII University, Bobigny, and Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris V University, Paris, France
Fig 2.
C
atamenial 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. Address correspondence to Dr Bagan, Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, 20-40 Rue Leblanc, 75908 Paris, France; e-mail: [email protected].
© 2006 by The Society of Thoracic Surgeons Published by Elsevier Inc
Fig 3.
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.
Reference 1. Bagan P, Le Pimpec Barthes F, Assouad J, Souilamas R, Riquet M. Catamenial pneumothorax: retrospective study of surgical treatment. Ann Thorac Surg 2003;75:378 – 81.
Ann Thorac Surg 2006;81:373 • 0003-4975/06/$32.00 doi:10.1016/j.athoracsur.2003.12.105
Magnetic Resonance Images of Diaphragmatic Endometriosis Treated by Polyglactin Mesh Patrick Bagan, MD, Francoise Le Pimpec-Barthes, MD, Emmanuel Martinod, MD, Michel Brauner, MD, PhD, Jacques F. Azorin, MD, and Marc Riquet, MD, PhD
Fig 1.
FEATURE ARTICLES
Departments of Thoracic and Vascular Surgery, and Radiology, Avicenne Hospital, Paris XIII University, Bobigny, and Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris V University, Paris, France
Fig 2.
C
atamenial 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. Address correspondence to Dr Bagan, Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, 20-40 Rue Leblanc, 75908 Paris, France; e-mail: [email protected].
© 2006 by The Society of Thoracic Surgeons Published by Elsevier Inc
Fig 3.
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.
Reference 1. Bagan P, Le Pimpec Barthes F, Assouad J, Souilamas R, Riquet M. Catamenial pneumothorax: retrospective study of surgical treatment. Ann Thorac Surg 2003;75:378 – 81.
Ann Thorac Surg 2006;81:373 • 0003-4975/06/$32.00 doi:10.1016/j.athoracsur.2003.12.105