Clinical features of thoracic endometriosis: A single center analysis

OBJECTIVE: To analyze the diagnostic profiles and treatment outcomes of patients with thoracic endometriosis at a university hospital. METHODS: A retrospective review of medical records was performed for patients diagnosed with thoracic endometriosis at Gangnam Severance Hospital, Yonsei University College of Medicine, between January 2007 and January 2014. RESULTS: Fifteen patients (median age, 35 years; range, 23-48 years) were evaluated. Patients presented with catamenial hemoptysis (n=8), or catamenial pneumothorax (n=7). Patients with catamenial pneumothorax were significantly older than those presenting with hemoptysis (P=0.0002). Only 3 patients (20%) had coexisting pelvic endometriosis. All patients underwent chest computed tomography; lesions were shown to predominantly affect the right lung (right lung, n=13, 86.7%; left lung, n=2, 13.3%), and were mainly distributed on the right upper lobe (n=9, 60%). Ten patients underwent video-assisted thoracoscopic surgery, and 1 patient underwent a thoracotomy. Intraoperatively, endometriosis-specific findings were observed in 8/11 patients (72.7%); a further 5/11 patients (45.4%) had histologically detectable endometriosis. Over the follow-up period (mean, 18.4 months; range, 2-65 months) 5/15 patients (33%) had clinical signs of recurrence. Recurrence was not detected in any of the 5 catamenial pneumothorax patients that received adjuvant hormonal therapy after surgery. CONCLUSION: The diagnosis and management of thoracic endometriosis requires a multidisciplinary approach, based upon skillful differential diagnosis, and involving careful gynecologic evaluation and assessment of the cyclicity of pulmonary symptoms. Imaging findings are non-specific, though there may be laterality towards the right lung. Since symptom recurrence is more common in those with presenting with pneumothorax, post-operative adjuvant medical therapy is recommended.

Catamenial Hemoptysis Treated by Video-assisted Thoracoscopic Surgery / 결핵및호흡기질환

Catamenial hemoptysis is a rare condition that's characterized by recurrent hemoptysis occurring in association with menstruation, and this is associated with the presence of intrapulmonary or endobronchial endometrial tissue. The diagnosis of pulmonary endometriosis can be made according to a typical clinical history and with exclusion of other causes of recurrent hemoptysis. Treatment of pulmonary endometriosis can be medical or surgical; however, the optimal management of this condition is still a matter of debate. Medical therapy may be problematic, due to recurrence of symptoms despite hormonal ablation, and adverse effects from long-term hormone therapy can also be a problem. We report here on a case of pulmonary endometriosis in a 23-year-old woman who presented with hemoptysis that occurred during the first 3 days of menstruation, and this happened over a 4 month period. She was successfully treated by video-assisted thoracoscopic surgery (VATS). No more hemoptysis was noted during 12 months of follow-up.

A case of catamenial hemoptysis / 대한산부인과학회지

Endometriosis is relatively common gynecologic diseases, but pulmonary endometriosis is exceedingly rare among various types of external endometriosis. Patients with pleural pulmonary endometriosis present with chest pain, dyspnea, pneumothorax or pleural effusion in relation to menstruation. Patients with parenchymal pulmonary endometriosis present with hemoptysis at the time of menstruation, with or without lung lesions on their chest X-ray. The diagnosis of pulmonary endometriosis is usually made on the basis of the clinical history and the exclusion of other causes of recurrent hemoptysis including tuberculosis, bronchial carcinoid, pulmonary infarction, chronic bronchitis, congenital abnormalities and carcinoma. It can be treated by progesterone, GnRH agonist, Danazol, surgical treatment etc. Hereby we experienced 23 year-old multiparous woman with catamenial hemoptysis. The site of disease/was localized with bronchoscopy and chest CT scanning, and we treated her with Danazol. The literature associated with pulmonary endometriosis is briefly reviewed.

A Case of Pulmonary Endometriosis Resected by Video-Assisted Thoracoscopic Surgery / 결핵

Catamenial hemoptysis is a rare condition caused by thoracic endometriosis that presents as tracheobronchial or pulmonary endometriosis. While hormonal treatment may cause virilization and sterility, due to the antiestrogenic effect, its surgical removal via thoracotomy is a particularly invasive procedure and is not recommended as the first choice treatment in young woman. Successful surgical removal by video-assisted thoracoscopic surgery (VATS) has recently been reported, and may be indicated for young patients who at some stage would like to become pregnant. Herein, a case of a 25-year-old unmarried woman with catamenial hemoptysis, cured by VATS, is reported.

A Case of Catamenial Hemoptysis Treated successfully with Gonadotropin-releasing Hormone (GnRH) Analogue / 결핵

Catamenial hemoptysis is syndrome characterized by bleeding from the bronchial trees and lungs that occurs synchronously with the female menstrual cycle. Etiologic mechanism of pulmonary endometriosis is still controversial, and the diagnosis is usually made on the basis of the clinical history and exclusion of other causes of recurrent hemoptysis. Serial computed tomograms of the chest during and in the interval between menstruations have been proved to be a useful confirmatory test. We experienced a 33-year-old female patient who had been previously diagnosed as pelvic endometriosis pathologically, experienced cyclic hemoptysis during menstruations. The diagnosis of pulmonary endometriosis was made based on her history and changes in the character of the lesions as documented on radiologic studies of the chest. She was treated successfully with GnRH analogue and there is no evidence of recurrence.

A Case of Parenchymal Pulmonary Endometriosis Diagnosed by Cytology of Bronchoalveolar Lavage Fluid / 대한임상병리학회지

Parenchymal pulmonary endometriosis has unique symptoms such as hemoptysis, dyspnea and chest pain in associated with menstruation. We experienced a case of parenchymal pulmonary endometriosis with the complaints of catamenial hemoptysis. Bronchoalveolar lavage(BAL) was performed when catamenial hemoptysis occurred. The BAL fluid showed many erythrocytes, hemosiderin-laden macrophages, and sheets of endometrial stromal cells.