KSTR Symposium 1998

Korean Society of Thoracic Radiology
The Korean Radiological Society


Case 1.

Diagnosis: BRONCHOPULMONARY  ENDOMETRIOSIS (catamenial lung)

FINDINGS
    Initial chest radiograph (9 June 1998) shows subtle ground glass opacity in left middle lung zone. HRCT scan (17 June 1998), performed 8 days after initial chest radiograph, shows poorly defined lobular ground glass density in the LLL superior segment, but there is no evidence of bronchiectasis or mass. One month later from chest PA 1, hemoptysis was relapsed. Chest radiograph (8 July 1998) and HRCT (17 May 1998) show similar findings as those of previous attack. In this time, ground glass opacity is denser than previous HRCT and there is another focus of ground glass opacity in the periphery of RLL anterior basal segment.
 

DISCUSSION
    Bronchopulmonary endometriosis is a disorder of parous women 30 to 50 years of age. There is often a clinical history of several spontaneous deliveries or uterine surgery, and the majority of patients do not have pelvic endometriosis. Generally, postmenopausal patients have no symptom while younger ones have had recurrent hemoptysis at the time of menstruations (catamenial hemoptysis) or 1-3 day before and after. "Catamenial" means monthly in Greek. There is usually a single focus of endometrial tissue in the lung parenchyma and occasionally in an airway, together with a variable amount of parenchymal hemorrhage.
    Radiologic study shows solitary, rounded nodules several centimeters in diameter or thin-walled cavitary lesions with septation and focal mural irregularity. Sometimes the dominant radiologic finding is the associated parenchymal bleeding, appearing as consolidation that comes and goes in phase with the a view to embolization had normal in appearance (1). Diagnosis can be made by MRI (4) but pulmonary or bronchial angiography are usually normal. Pleura is most common involved structure in thoracic endometriosis which menifested as recurrent pneumothorax or hemothorax. The mechanism of thoracic endometriosis is thought to be 3 way: 1) metaplasia, 2) direct implantation, and 3) metastasis. Pulmonary endometriosis is suggested to be metastasis.
    Catamenial hemoptysis has been successfully treated with antigonadotropin danazol. And some authors (2) has reported thoracoscopic pleurodesis or pleurectomy for hemothorax or pneumothorax caused by pleural endometriosis. Definite cure is impossible by surgical ablation only. However, peripheral localized pulmonary parenchymal lesion can be successfully treated especially in young women. Hysterectomy with oophorectomy or hormonal therapy replacing danazol also can be helpful (3).

REFERENCE
1. Imaging of Disseases of the Chest, Armstrong P, Wilson AG, Dee P, Hansell DM, second edition, 1995, Mosby, P694
2. Van Schuk PE, Vercauteren SR et al: Catamenial pneumothorax caused by thoracic endometriosis, Ann Thorac Surg, Aug 1996, 62(2) P585-586
3. Espaulella J, Armengol J, et al: Pulmonary endometriosis: conservative treatment with GnRH agonist, Obstet Gynecol, sep 1991,78(3 Pt2) P535-7
4. Cassing PC, Hauser M, Kacl G, et al: Catamenial hemoptysis. Diagnosis with MRI, Chest, May 1997, 111(5) p1447-50

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