Diaphragmatic Endometriosis

Evidence-based guides to diagnosing and treating endometriosis on the diaphragm, covering hallmark symptoms (cyclical chest/shoulder pain), causes, imaging, and surgical vs. medical options to help you seek timely, effective care.

Overview

Diaphragmatic endometriosis occurs when endometrial‑like tissue implants on the diaphragm, most often on the right side. Hallmark clues include cyclical pain in the shoulder, chest, or right upper abdomen that worsens around menstruation, sometimes with neck or trapezius pain, shortness of breath, or hiccups. It frequently coexists with pelvic disease and forms part of the deep infiltrating endometriosis spectrum, so coordinated evaluation helps map all involved sites.

Diagnosis relies on the symptom pattern plus targeted imaging. Pelvic and diaphragmatic MRI with dedicated sequences can show plaques, nodules, or fenestrations, while Ultrasound helps assess accompanying pelvic disease; imaging can miss small lesions, making laparoscopy both a diagnostic and therapeutic step. Management ranges from hormonal suppression to reduce bleeding‑driven inflammation to laparoscopic excision when nodules cause persistent pain or thoracic complications. Guidance spans how imaging findings shape decisions, when to involve a thoracic surgeon, and what recovery entails, with related resources in Deep Infiltrating Endometriosis, Surgery, and Excision Surgery.

How can I tell if shoulder or chest pain is related to diaphragmatic endometriosis?

Pain that is cyclical, right‑sided, and flares just before or during menstruation is suggestive, especially if it radiates to the neck or shoulder and worsens with deep breaths. Noncyclical or left‑sided pain has many other causes, so a careful history and exam help distinguish it from gallbladder, cardiac, or musculoskeletal issues.

What tests are best for diagnosing diaphragmatic endometriosis?

Diaphragm‑focused MRI can reveal nodules, plaques, or small defects, and pelvic Ultrasound assesses coexisting pelvic disease. Even with high‑quality imaging, small or superficial lesions may be missed, so laparoscopy remains the definitive way to confirm and treat lesions when suspicion is high.

When should I seek urgent care for thoracic symptoms?

Sudden severe chest pain or shortness of breath around menstruation can signal catamenial pneumothorax or hemothorax and needs emergency evaluation. Recurrent right‑sided chest pain episodes should prompt referral to teams experienced in thoracic endometriosis for coordinated care.

Can medication manage diaphragmatic endometriosis, or is surgery required?

Hormonal therapies such as continuous combined pills, progestins, the LNG‑IUD, or GnRH analogs can reduce bleeding‑driven irritation and ease pain, often combined with strategies from Pain Relief. Persistent symptoms, visible nodules, or thoracic complications may warrant laparoscopic excision, sometimes alongside thoracic surgery, as outlined in Surgery and Excision Surgery.

What does recovery look like after diaphragmatic excision?

Most patients go home the same day or next, with temporary shoulder pain common from surgical gas and diaphragmatic manipulation. Breathing exercises, early ambulation, and a graded return to activity support recovery, while follow‑up addresses recurrence risk and any need for adjunct medical therapy.