Thoracic endometriosis with catamenial haemoptysis and pneumothorax: computed tomography findings and long-term follow-up after danazol treatment

Thoracic endometriosis (TE) is an uncommon disorder affecting women of childbearing age. We herein report clinical and thin-section computed tomography (CT) findings of two cases, in which one woman presented with catamenial haemoptysis (CH) alone and another woman presented with bilateral catamenial pneumothoraces (CP) coinciding with CH, a rare manifestation of TE. The dynamic changes demonstrated on thin-section chest CT performed during and after menses led to accurate localisation and presumptive diagnosis of TE in both patients. Following danazol treatment, the patient with CH alone had a complete cure, while the patient with CP and CH had an incomplete cure and required long-term danazol treatment. We discuss the role of imaging studies in TE, with an emphasis on the appropriate timing and scanning technique of chest CT in women presenting with CH, potential mechanisms, treatment and patient outcomes.

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.

Video-Assisted Thoracic Surgery for Pulmonary Endometriosis: Report of 1 Case / 결핵및호흡기질환

Pulmonary endometriosis is an uncommon disease, and usually detected by catamenial hemoptysis. Treatment of pulmonary endometriosis may be medical(hormone therapy) or surgical. Since hormone therapy may cause sterility, most of patients who wish to conceive usually choose surgical resection. Although video-assisted thoracic surgery(VATS) has advantage of small scar, reducing postoperative pain and shortening hospital stay, it is not easy to locate the precise lesion and resect whole endometrial tissue not to be remained. 17 years old female with catamenial hemoptysis was treated sucessfully with a partial resection of the lung using VATS, and has been asymptomatic for 7months since the operation.

Three Cases of Parenchymal Pulmonary Endometriosis / 대한산부인과학회잡지

Parencymal pulmonary endometriosis is a rare gynecologic problem, characterized by cyclic hemoptysis. Lung is the origin of hemoptysis. The diagnosis is based upon the clinical history and exclusion of other causes of recurrent hemoptysis, changes in the radiologic findings of chest lesion associated with menstrual cycle. We describe three women with recurrent hemoptysis during menstruation and localized lesion on computerized tomography (CT) scanning. The patients were treated with gonadotropin releasing hormone (GnRH) agonist or surgery. We represent three cases with a brief review of literature.

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 Endometriosis at the Site of Abdominal Scar following Cesarean Section and A Case of Parenchymal Pulmonary Endometriosis / 대한산부인과학회잡지

Abdominal wall endometriosis secondary to cesarean section is very rare condition, being reported in less than 0.5% of patients undergoing cesarean section. Moreover, parenchymal pulmonary endometriosis is a rare gynecologic problem, characterized by cyclic hemoptysis. We experienced 38 years old female patient who had had cyclically appearing painful abdominal wall mass after cesarean section pathologically proven endometriosis and 33 year-old female patient with recurrent catamenial hemoptysis localized with CT scanning, and then treated with GnRH agonist. So, we present two cases with a brief review of literatures.

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.

Pulmonary Endometriosis / 결핵

Endometriosis is defined as an extrauterine growth of endometrial tissue and it is primarily limited in the pelvis but it can also occur in the pleural cavity as well as pulmonary parenchyme. The diagnosis of pulmonary endometriosis is usually based on the clinical history of recurrent hemoptysis in association with menstrual cycle and by histopathologic confirmation of endometrial tissue in the lung parenchyme. Pulmonary endometriosis was first reported by Lattes in 1956, and dozens of cases have been reported so far. We experienced a case of 25 year old single woman with a history of hemoptysis in association with her menstruation. The bleeding focus was localized with chest CT scan and repeated fibrooptic bronchoscopy and basal segmentectomy of the right lower lobe was performed. The resected specimen shows endometrial stroma and glands of early proliferative phase with respiratory epithelium on the laterobasal bronchus. Her postoperative course was uneventful with no recurrence of hemoptysis during 6 months of follow-up in the outpatient clinic.

A case of parenchymal pulmonary endometriosis

Pulmonary Endometriosis is a rare disease entity and we report a 23-year-old single woman with a history of hemoptysis in association with menstruation. She was previously treated effectively with hormone therapy for 3 months, but decided to undergo surgical resection because of the high cost of hormone therapy. Radiographic finding of the chest showed haziness in the right lower lung field, and chest CT showed a ground-glass appearance in the posterobasal and laterobasal segment. The patient underwent basal segmentectomy of the right lower lobe. There was no incidence of hemoptysis during her menstruation following the operation.