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Weekly Chest CasesArchive of Old Cases

Case No : 558 Date 2008-07-07

  • Courtesy of Hye-Jeong Lee, MD, Byoung Wook Choi, MD, Ji Eun Nam, MD, Jin Hur, MD, Young Jin Kim, MD, Kyu Ok Choe, MD. / Severance Hospital, Yonsei University Health System, Korea.
  • Age/Sex 28 / F
  • Chief ComplaintHemoptysis
  • Figure 1
  • Figure 2

Diagnosis With Brief Discussion

Diagnosis
Pulmonary endometriosis (catamenial hemoptysis)
Radiologic Findings
Chest CT images show a round-shaped ground glass opacity (GGO), and ill-defined nodules within the GGO in the left lower lobe.
Brief Review
Pulmonary endometriosis is uncommon, and the diagnosis is usually established on clinical grounds. The two theories entertained for the development of pulmonary endometriosis are microembolization and peritoneal-pleural migration. In the microembolization theory, it is postulated that endometrial tissue can be transported through the lymphatic or vascular channels to the lung parenchyma. Alternatively, endometrial tissue may involve the pleura by migrating from the peritoneal cavity to the pleural cavity through diaphragmatic defects. Pleural lesions are almost exclusively right-sided, whereas lung lesions have no such predilection. Regardless of pathophysiology, pulmonary endometriosis is generally associated with coexistent pelvic endometriosis and usually occurs 5 years after the diagnosis of pelvic endometriosis. Notably, however, in some cases pulmonary lesions may actually represent embolic decidua or trophoblastic tissue and are not from preexisting endometriosis.

Reported CT findings of pulmonary endometriosis include ill-defined opacities several centimeters in size, nodules, areas of consolidation or ground glass opacity surrounding the nodules, thin-walled cavities, and bullae. Interestingly, these lesions may vary in size during the menstrual cycle and may disappear after the cessation of menstruation.

Treatment for recurrent complication was more successful with surgical pleurodesis than with medical management.
References
1. Joseph J, Sahn SA. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med 1996; 100:164-170.
2. Paula J. Woodward, Roya Sohaey, and Thomas P. Mezzetti, Jr. Endometriosis: Radiologic-Pathologic Correlation. RadioGraphics 2001; 21: 193-216.
Keywords
Lung,

No. of Applicants : 93

▶ Correct Answer : 47/93,  50.5%
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - Samsung Medical Center , Korea (South) Dae Kun Oh
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun JunYeh
  • - kims,narkatpally , India k bhaskar
  • - Osaka University , Japan Osamu Honda
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - Soon chun hyang university hospital bucheon , Korea (South) Hyelin Kim
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - Naval Education & Traning Command , Korea (South) Young Choi
  • - Soonchunhyang University Cheonan Hospital , Korea (South) Park Sang Hyun
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Dongguk University International Hospital , Korea (South) Ah-young Kim
  • - Seoul National University Hospital , Korea (South) Chang Min Park
  • - samsung medical center , Korea (South) Tae Yeon Jeon
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - All India Institute of Medical Sciences , India Subhash kumar
  • - hospital Sao Paulo , Brazil israel missrie
  • - Changhua Christian Hospital , Taiwan Chia-Fu Tsai
  • - Samsung Medical Center , Korea (South) Eun Young Kim
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - Asan Medical Center , Korea (South) Seong Yun Kim
  • - Depatment of Radiology, Yongsan Hospital, College of Medicine, Chung-Ang University , Korea (South) Jae Seung Seo
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - All India Institute of Medical Sciences , India puneet kochar
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Kosin University , Korea (South) Woonha Lee
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Kwang Myung Sungae Hospital , Korea (South) Jiyong Rhee
  • - Seoul National University Hospital , Korea (South) Kwang Nam Jin
  • - Department of Radiology, Gachon University, Gil Medical Center , Korea (South) young sup shim
  • - Hanyang university , Korea (South) Ji Young Kim
  • - Good Gangan Hospital , Korea (South) Kyung Hwa Jung
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - .... , Korea (South) Soo Jin Choi
  • - Yonsei University college of medicine Severance hospital , Korea (South) Hua Sun Kim
  • - Saga University , Japan Ryoko Egashira
  • - radiology department ANNECY , France gilles GENIN
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Central Queensland Medical Imaging , Australia Sandeep Joshi
  • - All India Institute of medical sciences , India Justin Moses
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - All India Institute of Medical Sciences , India Ashish Gupta
▶ Correct Answer as Differential Diagnosis : 4/93,  4.3%
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - Deenanath Mangeshkar Hospital, Pune , India Anubhav Khandelwal
  • - CHU de Nancy, Hopital de Brabois , France Abraham Bohadana
  • - Pe d , France Fabrice Bing
▶ Semi-Correct Answer : 7/93,  7.5%
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - OSWAL CANCER HOSPITAL , India LOVKESH MITTAL
  • - Cheongshim international medical center , Korea (South) Yang Hae Jum
  • - BHMRC , India nidhi goyal
  • - IRSA La Rochelle France , France Denis Chabassie
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - PITTWATER RADIOLOGY , Australia Julie Arora
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