QC: Does Imaging Catch Thoracic Endometriosis

Dr. Francesco Di Chiara explains why detecting thoracic endometriosis with MRI presents three major challenges. Radiologists trained to spot round lesions often miss the thin, widespread deposits in the chest, while technical limitations and breathing movements further complicate imaging of the diaphragm—the most common site for thoracic endometriosis.

• MRI with specific endometriosis protocols remains the best available imaging option
• Radiologists often look for round lesions that rarely exist in thoracic endometriosis
• Thin lesions frequently fall below MRI resolution capabilities
• The diaphragm, where endometriosis commonly occurs, suffers from breathing movement artifacts during imaging
• Endometriosis can penetrate through the diaphragm and occasionally into lung tissue
• Rare cases of airway endometriosis exist but are difficult to diagnose with bronchoscopy
• Dr. Di Chiara is working on a classification system for diaphragmatic endometriosis

Do you have more questions? Keep them coming by using the link in the description, emailing contact@endobattery.com, or visiting the endobattery.com contact page.

Chapters

• 0:00 Quick Connect Introduction
• 0:47 Dr. Di Chiara's Expertise Introduction
• 1:36 Imaging Challenges for Thoracic Endometriosis
• 2:48 Diaphragm and Deep Infiltrative Disease
• 4:23 Episode Conclusion and Contact Information

Transcript

Speaker 1: 0:00

Life moves fast and so should the answers to your biggest questions. Welcome to EndoBattery's Quick Connect, your direct line to expert insights Short, powerful and right to the point. You send in the questions, I bring in the experts and in just five minutes you get the knowledge you need. No long episodes, no extra time needed, and just remember expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question? Send it in and let's quickly get you the answers. I'm your host, alana, and it's time to connect.

Speaker 1: 0:47

Today I am joined at the table by my guest, dr Francesco Di Chiara, a leading consultant thoracic surgeon at the John Radcliffe Hospital in Oxford and a true pioneer in minimally invasive chest surgery. Renowned internationally for developing and refining cutting edge techniques, including groundbreaking single incision procedure for thoracic outlet syndrome, dr D Chiara is transforming the way we approach complex thoracic conditions, with deep expertise in lung cancer, chest wall trauma and rare disorders like thoracic endometriosis. He's not only a gifted surgeon, but also a passionate educator and an innovator. I am thrilled to be diving into this conversation with someone who is shaping the future for thoracic endometriosis. Please help me in welcoming Dr Francesco Di Chiara, is there imaging that can help detect thoracic endometriosis, or is?

Speaker 1: 1:35

that similar to the pelvis. Where it's hard, it's similar to the pelvis?

Speaker 2: 1:41

It probably was. So the best investigation that we have now is the same, is MRI with specific endometriosis protocol and with E1 fat saturated and so on. So there are two main barriers for diagnosis. One is the training of radiologists, which I often discuss with because I think they want to find a reassuring finding of the round endometrial one which is a solid, definite lesion. It's almost never there in the chest and they're often very thin and widespread lesions, the nooks and crannies of the chest. And the second main barrier is that the lesions are thin and below the resolution of the MRI.

Speaker 2: 2:28

And I can add a third barrier to the diagnosis the most common area where the endometriosis in the chest is present is the diaphragm, which is the area where there are more movement artifacts, because MRI is not a breath-hold investigation. So during an MRI we don't hold a breath for 30 minutes, obviously, so we keep breathing and the acquisition, although filtered through algorithms and computer system, is still a bit artifact, movement artifacts. So what you should have the highest resolution is actually when you get the least resolution. Interesting.

Speaker 1: 3:02

MRIs. How deep can these lesions? Go though Resolution is actually where you get the least resolution Interesting. How deep can these lesions go, Though I mean, we're talking some superficial, but how deep can they go? Can they go into the lung? Can they go even deeper than that?

Speaker 2: 3:16

They can definitely go through the diaphragm and I'm trying to work together to build a classification in deep infiltrative diaphragmatic disease and non-deep infiltrative diaphragmatic disease, no-transcript and also the aesthetic and going the lung. I've seen anecdotal cases of lung endometriosis I was at least lucky enough, but I often don't see any cases that are severe. I certainly have seen in the prura, so the lining of the lung, and I've seen a lot of deep infiltrative endometriosis in the diaphragm and I have at least about five, six cases of very suspicious airway endometriosis. But it's very difficult to catch because it's although I've done bronchoscopy, a camera test of the airway it's normally located very peripherally where the airway is so thin that you can't fit the bronchoscope in even using a thin one.

Speaker 1: 4:23

That's a wrap for this quick connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming, send them in and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at endobatterycom or visiting the endobatterycom contact page. Until next time, keep feeling empowered through knowledge.