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

Abstract

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 longterm 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 Pneumothorax

“…Incomplete surgical treatment of lesions and lack of additional hormonal treatment in the early postoperative period [23,24,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] may increase the risk of recurrence [24,30,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56].…”

Pulmonary endometriosis: an unusual cause of hemoptysis

“…This condition most frequently affects women of reproductive age with a history of pelvic surgery, childbirth, or surgical procedures involving the uterine cavity. 1 - 3 Thoracic endometriosis, involving the pleura and pulmonary parenchyma, can occur, manifesting as the well-recognized clinical entities of catamenial pneumothorax, catamenial hemothorax, and catamenial hemoptysis, as well as nodules in the pleura or lung. Although the CT findings of thoracic endometriosis are relatively nonspecific, CT continues to be the first-line imaging method, because it can be used to rule out other diagnoses and map lesions for surgery.…”

“…Pleural endometriosis is more common than is pulmonary endometriosis. 1 - 3 , 7 , 8 In most cases, pulmonary endometriosis is thought to result from embolization of endometrial tissue to the lung parenchyma. Rupture of the capillaries or alveoli within the lesion during menstruation can result in hemoptysis or pneumothorax.…”

“…Absorption of the hemorrhagic lesions then occurs between menstruations. 1 - 3 , 8 The diagnosis of pulmonary endometriosis is established on the basis of recurrent hemoptysis that is synchronized with the menstrual cycle, together with persistent, pathologically confirmed foci of endometriosis. Symptoms manifest during menstruation and then disappear.…”

“…The size and severity of the lesions during menstruation differ significantly from those in the period between menses. 1 , 3 , 8 Histopathological findings include uterine endometrial cells with features of proliferative or secretory endometrium. 8 Treatments include hormonal therapy and surgical resection.…”