Hemoptysis and Endometriosis: An Unusual Association — Case Report and Review of the Literature

Abstract

Thoracic endometriosis syndrome is a rare condition that includes four entities: catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis and lung nodules. We describe the case of a 23-year-old woman with complaints of hemoptysis during menstrual period in the two years prior to the appointment. Initially, a treatment for tuberculosis was established with no success. Further investigation showed a 4 mm nodule in the right lung, and the transvaginal ultrasonography indicated the presence of deep endometriosis. Considering the occurrence of symptoms only during menses, an empirical therapy was instituted with remission of the complaints.

Management of women affected by endometriosis: Are we stepping forward?

“…The catamenial character of these symptoms is related to the menstrual cycle. 22,23 The intestine involvement manifestations are represented by rectal bleeding with pain, cramping, and the alternating constipation and diarrhea. [24][25][26] Ureteral endometriosis may still remain asymptomatic; however, it can lead to signs of urinary tract obstruction such as hydroureter and hydronephrosis until the involvement of renal function that usually occurs when ureteral endometriosis is presented bilaterally (although this condition represents a rare complication).…”

“…The catamenial character of these symptoms is related to the menstrual cycle. 22,23 The intestine involvement manifestations are represented by rectal bleeding with pain, cramping, and the alternating constipation and diarrhea. 24–26…”

Thoracic Endometriosis presented as catamental hemoptysis: Fourteen Cases of a Rare Disease and the hormonal treatment management

“…Thoracic endometriosis syndrome (TES) is a rare disease in which a functioning endometrial tissue is observed in the pleura, lung parenchyma, airways, or diaphragm [1][2][3][4]. The clinical manifestations of thoracic endometriosis are catamenial pneumothorax (CP) [5], catamenial hemoptysis (CH), catamenial hemothorax (CHT) [6,7] and lung nodules [8].…”

“…The most common anatomical location of endometriosis is pelvic cavity, and it is rarely found in extra pelvic cavity [13]. The extragenital endometriosis represents 5-12% of endometriosis [1,2] and has been reported in multiple organ and systems, such as urinary tract [14], brain [15], gastrointestinal tract [16] and lungs. Though the prevalence of endometriosis is around 15% [17], the extragenital endometriosis represents 5% of the localizations [1], and the TES is very rare [13], and it is even rarer to have TES with catamental hemoptysis as the main clinical manifestation, so the prevalence and etiology of thoracic endometriosis is unknown as most data comes from simple case reports or short series [13].…”

“…Various modalities from long-term use of hormonal agents [18,19] including androgen derivatives, gonadotropin-releasing hormone agonists (GnRH-a), and oral contraceptives, to surgical resection such as chemical pleurodesis, pleurectomy, and segmental resection have been experimented in the treatment of TES [20,21]; however, the optimal management of this disease remains a matter of debate [1]. Here, we report 14 cases with a high level of clinical suspicion and characteristics with periodic changes of the lesions in the chest CT scan and their effective hormonal treatment and management.…”