Thoracic endometriosis

Changed by Henry Knipe, 11 Jul 2016
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Thoracic endometriosis is an uncommon location for endometriosis.

Epidemiology

Most often occurs in the third and fourth decades of life.3.

PathogenesisClinical presentation

Pathology

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 extensive decidual adhesions and distortion of tissue, which leads to the classical catamenial pain and haemoptysis.2.

Location

There is a predilection for right sided involvement in case of pleural endometriosis, however in parenchymal involvement there is no such predilection seen.

Clinical presentation

Radiographic features

HRCT chest CT

HRCT is the modality of choice for thoracic endometriosis, which may demonstrate presence of pneumothorax, hemothoraxhaemothorax 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 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.

  • -<p><strong>Thoracic endometriosis</strong> is an uncommon location for <a href="/articles/endometriosis">endometriosis</a>.</p><h4>Epidemiology</h4><p>Most often occurs in the third and fourth decades of life.<sup>3</sup></p><h4>Pathogenesis </h4><p>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.<sup>1</sup></p><p>Exact pathogenesis of thoracic endometriosis is elusive. The theories postulated are </p><ul>
  • -<li>due to in utero pleural metaplasia into pleural endometrial tissue</li>
  • -<li>retrograde mensturation with further thoracic implantation of endometrial tissue by transdiaphragmatic passage  </li>
  • -<li>hematogenic migration post a surgical gynecological procedure</li>
  • -</ul><p>Post implantation of endometrial tissue there is extensive decidual adhesions and distortion of tissue, which leads to the classical catamenial pain and haemoptysis.<sup>2</sup></p><h5>Location</h5><p>There is a predilection for right sided involvement in case of pleural endometriosis, however in parenchymal involvement there is no such predilection seen.</p><h4>Clinical presentation</h4><ul>
  • +<p><strong>Thoracic endometriosis</strong> is an uncommon location for <a href="/articles/endometriosis">endometriosis</a>.</p><h4>Epidemiology</h4><p>Most often occurs in the third and fourth decades of life <sup>3</sup>.</p><h4>Clinical presentation</h4><ul>
  • -<li>catamenial <a href="/articles/haemoptysis-1">haemoptysis</a> - endometrial tissue in bronchial tree</li>
  • +<li>catamenial <a href="/articles/haemoptysis-1">haemoptysis</a>: endometrial tissue in bronchial tree</li>
  • -<a href="/articles/catamenial-pneumothorax">catamenial pneumothorax</a> - endometrial tissue in periphery </li>
  • +<a href="/articles/catamenial-pneumothorax">catamenial pneumothorax</a>: endometrial tissue in periphery </li>
  • -<a href="/articles/catamenial-haemothorax">catamenial haemothorax</a> - endometrial tissue in periphery </li>
  • +<a href="/articles/catamenial-haemothorax">catamenial haemothorax</a>: endometrial tissue in periphery </li>
  • -</ul><h4>Radiographic features</h4><h5>HRCT chest </h5><p>HRCT is the modality of choice for thoracic endometriosis, which may demonstrate presence of pneumothorax, hemothorax 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.</p><h4>Treatment</h4><p>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.</p>
  • +</ul><h4>Pathology</h4><p>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 <sup>1</sup>.</p><p>Exact pathogenesis of thoracic endometriosis is elusive. The theories postulated are:</p><ul>
  • +<li>due to in utero pleural metaplasia into pleural endometrial tissue</li>
  • +<li>retrograde mensturation with further thoracic implantation of endometrial tissue by transdiaphragmatic passage  </li>
  • +<li>hematogenic migration post a surgical gynecological procedure</li>
  • +</ul><p>Post implantation of endometrial tissue there is extensive decidual adhesions and distortion of tissue, which leads to the classical catamenial pain and haemoptysis <sup>2</sup>.</p><h5>Location</h5><p>There is a predilection for right sided involvement in case of pleural endometriosis, however in parenchymal involvement there is no such predilection seen.</p><h4>Radiographic features</h4><h5>CT</h5><p>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 <a title="Ground glass opacities (GGO)" href="/articles/ground-glass-opacification">ground glass opacities</a>.  HRCT may also be used to provide guidance for targeted biopsy. Imaging should be carried out during menstruation for higher sensitivity.</p><h4>Treatment and prognosis</h4><p>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.</p>

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