QC: Does Imaging Catch Thoracic Endometriosis

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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

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Episode Transcript

Speaker 1 (00:00):
Life moves fast and so should the answers to your
biggest questions.
Welcome to EndoBattery's QuickConnect, your direct line to
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(00:20):
expert opinions shared here arefor general information and not
for personalized medical advice.
Always consult your providerfor your case-specific guidance.
Got a question?
Send it in and let's quicklyget you the answers.
I'm your host, alana, and it'stime to connect.

(00:47):
Today I am joined at the tableby my guest, dr Francesco Di
Chiara, a leading consultantthoracic surgeon at the John
Radcliffe Hospital in Oxford anda true pioneer in minimally
invasive chest surgery.
Renowned internationally fordeveloping and refining cutting
edge techniques, includinggroundbreaking single incision
procedure for thoracic outletsyndrome, dr D Chiara is

(01:07):
transforming the way we approachcomplex thoracic conditions,
with deep expertise in lungcancer, chest wall trauma and
rare disorders like thoracicendometriosis.
He's not only a gifted surgeon,but also a passionate educator
and an innovator.
I am thrilled to be diving intothis conversation with someone
who is shaping the future forthoracic endometriosis.

(01:27):
Please help me in welcoming DrFrancesco Di Chiara, is there
imaging that can help detectthoracic endometriosis, or is?
that similar to the pelvis.
Where it's hard, it's similarto the pelvis?

Speaker 2 (01:41):
It probably was.
So the best investigation thatwe have now is the same, is MRI
with specific endometriosisprotocol and with E1 fat
saturated and so on.
So there are two main barriersfor diagnosis.
One is the training ofradiologists, which I often
discuss with because I thinkthey want to find a reassuring

(02:04):
finding of the round endometrialone which is a solid, definite
lesion.
It's almost never there in thechest and they're often very
thin and widespread lesions, thenooks and crannies of the chest
.
And the second main barrier isthat the lesions are thin and

(02:24):
below the resolution of the MRI.
And I can add a third barrier tothe diagnosis the most common
area where the endometriosis inthe chest is present is the
diaphragm, which is the areawhere there are more movement
artifacts, because MRI is not abreath-hold investigation.
So during an MRI we don't holda breath for 30 minutes,

(02:46):
obviously, so we keep breathingand the acquisition, although
filtered through algorithms andcomputer system, is still a bit
artifact, movement artifacts.
So what you should have thehighest resolution is actually
when you get the leastresolution.
Interesting.

Speaker 1 (03:02):
MRIs.
How deep can these lesions?
Go though Resolution isactually where you get the least
resolution Interesting.
How deep can these lesions go,Though I mean, we're talking
some superficial, but how deepcan they go?
Can they go into the lung?
Can they go even deeper thanthat?

Speaker 2 (03:16):
They can definitely go through the diaphragm and I'm
trying to work together tobuild a classification in deep
infiltrative diaphragmaticdisease and non-deep
infiltrative diaphragmaticdisease, no-transcript and also

(03:39):
the aesthetic and going the lung.
I've seen anecdotal cases oflung endometriosis I was at
least lucky enough, but I oftendon't see any cases that are
severe.
I certainly have seen in theprura, so the lining of the lung
, and I've seen a lot of deepinfiltrative endometriosis in
the diaphragm and I have atleast about five, six cases of

(04:04):
very suspicious airwayendometriosis.
But it's very difficult tocatch because it's although I've
done bronchoscopy, a cameratest of the airway it's normally
located very peripherally wherethe airway is so thin that you
can't fit the bronchoscope ineven using a thin one.

Speaker 1 (04:23):
That's a wrap for this quick connect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming, send them inand I'll bring you the expert
answers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact
at endobatterycom or visitingthe endobatterycom contact page.

(04:48):
Until next time, keep feelingempowered through knowledge.