{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T02:57:03Z","timestamp":1781233023131,"version":"3.54.1"},"reference-count":46,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Catamenial pneumothorax is a rare form of recurrent spontaneous pneumothorax occurring in women in temporal association with the menstrual cycle, most commonly within 72 h before or after the onset of menstruation, and is frequently encountered as part of thoracic endometriosis syndrome. Thoracic endometriosis represents an extrapelvic manifestation of endometriosis in which ectopic endometrial tissue may involve the pleura, diaphragm, lung parenchyma, or airways, leading to cyclic pleuropulmonary symptoms. The clinical spectrum includes catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis, and pulmonary endometriotic nodules. This narrative review critically analyzes the diagnostic challenges and limitations of imaging modalities in thoracic endometriosis, with particular emphasis on diagnostic delay, radiological pitfalls, and the discrepancy between morphological detection and etiological confirmation. Chest radiography and computed tomography are useful for documenting acute thoracic events, whereas magnetic resonance imaging may provide additional tissue characterization in selected cases, particularly when hemorrhagic or diaphragmatic lesions are suspected. However, imaging findings are often nonspecific, temporally variable, and insufficient to establish the diagnosis when interpreted in isolation. Recognition of thoracic endometriosis therefore requires correlation of imaging findings with menstrual cyclicity, gynecological history, clinical phenotype, and, when indicated, surgical and histopathological assessment. The available evidence remains limited by retrospective designs, small case series, inconsistent diagnostic criteria, and lack of validated thoracic-specific imaging pathways. Accordingly, an integrated clinical\u2013radiological\u2013surgical approach should be regarded as a pragmatic diagnostic framework rather than a validated algorithm. Such an approach may improve clinical suspicion, reduce diagnostic delay, and support more appropriate multidisciplinary management of this underrecognized condition.<\/jats:p>","DOI":"10.3390\/jcm15124517","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T01:52:08Z","timestamp":1781229128000},"page":"4517","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Thoracic Endometriosis and Catamenial Pneumothorax: Imaging Pitfalls and an Integrated Diagnostic Approach"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5128-9045","authenticated-orcid":false,"given":"Marija Varnicic","family":"Lojanica","sequence":"first","affiliation":[{"name":"U\u017eice General Hospital, 31000 U\u017eice, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3269-3069","authenticated-orcid":false,"given":"Stefan","family":"Ivanovic","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Clinic \u201cNarodni Front\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8143-5828","authenticated-orcid":false,"given":"Nikola","family":"Milic","sequence":"additional","affiliation":[{"name":"U\u017eice General Hospital, 31000 U\u017eice, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3269-1577","authenticated-orcid":false,"given":"Nikola","family":"Jovic","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"},{"name":"Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0253-691X","authenticated-orcid":false,"given":"Nenad","family":"Rakic","sequence":"additional","affiliation":[{"name":"Senta General Hospital, 24400 Senta, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Pilic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9176-9736","authenticated-orcid":false,"given":"Katarina","family":"Ivanovic","sequence":"additional","affiliation":[{"name":"Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"Matijasevic","sequence":"additional","affiliation":[{"name":"U\u017eice General Hospital, 31000 U\u017eice, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dejana","family":"Rakic","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9625-0626","authenticated-orcid":false,"given":"Jovana","family":"Joksimovic Jovic","sequence":"additional","affiliation":[{"name":"Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"},{"name":"Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3144-0779","authenticated-orcid":false,"given":"Milica","family":"Ivanovic","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Clinic \u201cNarodni Front\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"382","author":"Zondervan","year":"2020","journal-title":"N. 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