Most often occurs in the third and fourth decades of life 3.
Symptoms may include:
- catamenial pleuritic chest pain
- catamenial haemoptysis: when endometrial tissue in the bronchial tree
- catamenial pneumothorax: when endometrial tissue in the lung periphery
- catamenial haemothorax: when endometrial tissue the in periphery
- lung nodule
Endometriosis is the presence of functioning endometrial tissue in extrauterine locations. It is most often confined to the pelvis; however extrapelvic sites like umbilicus, scar sites in abdomen, breasts, extremities and thorax may also be involved. In thorax the sites to be involved are pleura, parenchyma, airways and the diaphragm 1.
Exact pathogenesis of thoracic endometriosis is elusive. The theories postulated are:
- due to in utero pleural metaplasia into pleural endometrial tissue
- retrograde mensturation with further thoracic implantation of endometrial tissue by transdiaphragmatic passage
- hematogenic migration post a surgical gynecological procedure
Post implantation of endometrial tissue there is extensive decidual adhesions and distortion of tissue, which leads to the classical catamenial pain and haemoptysis 2.
There is a predilection for right sided involvement in case of pleural endometriosis, however in parenchymal involvement there is no such predilection seen.
HRCT is the modality of choice for thoracic endometriosis, which may demonstrate presence of pneumothorax, haemothorax or nodules which may change in nature cyclically. There may sometimes be vague areas of bronchial wall thickening, thin walled cavities, bullous formation or ground glass opacities. HRCT may also be used to provide guidance for targeted biopsy. Imaging should be carried out during menstruation for higher sensitivity.
Treatment and prognosis
The treatment options are medical or surgical. Gonadotropin releasing hormone agonists are recommended for treatment of extrapelvic endometriosis. The other options are lung resection using VATS.
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