QC: Does Imaging Catch Thoracic Endometriosis

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Speaker 1
0:00

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Dr. Di Chiara's Expertise Introduction

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

Imaging Challenges for Thoracic Endometriosis

Speaker 1
1:36

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

Diaphragm and Deep Infiltrative Disease

Speaker 2
2:48

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
.

Episode Conclusion and Contact Information

Speaker 1
4:23

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