Pulmonary cavitations with increased 18F-FDG uptake revealing a thoracic endometriosis

Abstract

Rationale: Thoracic endometriosis is a rare disorder that can involve airways, pleura and lung parenchyma. It is the most frequent form of extra-abdominopelvic endometriosis. Multiple lung cavitations are a rare feature of thoracic endometriosis. Patient concerns: A 46-year-old woman was referred to our hospital after incidental finding of multiple pulmonary cavitations with surrounding areas of ground glass opacity on a thoraco-abdominal computed tomography-scan performed for abdominal pain. Retrospectively, the patient also reported mild hemoptysis occurring 4 months ago. Diagnoses: Positron emission tomography–computed tomography scan revealed moderate and homogeneous [ 18 F] fluoro-2-deoxy-D-glucose ( 18 F-FDG) uptake in pulmonary cavitations (maximum standardized uptake value 5.7). The diagnosis of thoracic endometriosis was confirmed by histological examination of surgical resection of a left lower lobe cavitation. Interventions and outcome: Gonadotropin-releasing hormone analogues associated with add-back therapy was started. Four months after initiating pharmacological treatment, the chest computed tomography-scan showed a dramatic decrease in lung cavitations size. Lessons: Thoracic endometriosis is a rare disorder requiring a multidisciplinary management including gynaecologist, pulmonologist, radiologist, nuclear physician, pathologist and thoracic surgeon for early diagnosis and treatment. Our case report highlights that an increased 18 F-FDG uptake can be found in thoracic endometriosis syndrome presenting as multiple lung cavitations.

Advances in Imaging for Assessing Pelvic Endometriosis

“…Although performed in small study populations and mainly in the case of extragenital endometriosis, positron emission tomography–computed tomography with 16α-[18F]fluoro-17β-estradiol (FDG PET/CT) was proposed as a feasible technique [ 121 , 122 ]. In addition, Balogova et al stated that, in some cases, the presence of endometriosis interferes with the FDG PET/CT performed for another indication [ 123 ].…”

18F-FDG PET/CT to Spare Malignancy in a Rare Case of Lung Endometriosis

“…6 However, a significant FDG uptake has been reported in lung endometriosis in the literature. 7,8 Increased uptake of 18 F-FDG is usually associated with malignancy, 9 but it can also be seen in benign lung lesions and inflammatory lung lesions. 10,11 In our case, 18 F-FDG PET/CT was useful to rule out malignancy of the main lesion.…”

“…Some imaging modalities can be useful in the diagnosis of thoracic endometriosis syndrome, 5 but there is no an established role for PET/CT 6 . However, a significant FDG uptake has been reported in lung endometriosis in the literature 7,8 . Increased uptake of 18 F-FDG is usually associated with malignancy, 9 but it can also be seen in benign lung lesions and inflammatory lung lesions 10,11 .…”