대한흉부영상의학회 Weekly Chest Cases

Case No : 1182 Date 2020-06-16

Courtesy of Hye Young Kwon, Sung Shine Shim, Woocheol Kwon / Ewha Womans University Seoul Hospital
Age/Sex 47 / F
Chief Complaintminimal hemoptysis / PHx: hysterectomy (1 year ago)

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on admission

Diagnosis With Brief Discussion

Diagnosis: pulmonary endometrioma
Radiologic Findings: Figure 1. Chest PA shows an ill defined small nodule in the right lower cardiac border.
Figure 2-7. Axial and coronal CT images show a well defined 12mm sized subpleural nodule in RML which is highly enhanced after contrast injection (Figure 6-7). This nodule is attached at right anterior costal pleura and mediastinal fat. On follow up CT images after 3 years (on admission) (Figure 2-4), it is increased in size (1.2->2.6cm) with internal heterogeneous low attenuation suggesting some cystic change. PET/CT scan (Figure 5) demonstrates mild FDG uptake of this nodule.
Brief Review: Thoracic endometriosis may involve the trachea, bronchi, lung parenchyma, pleura or the diaphragm. Pleural and diaphragmatic endometriosis usually causes chest pain and dyspnea, and may be associated with pneumothorax, pleural effusion or hemothorax, whereas tracheobronchial and parenchymal subtypes of the disease may present with periodic hemoptysis simultaneous with patients' menses.
The radiological findings for catamenial hemoptysis are often normal, but they can show solitary or multiple pulmonary haziness-displaying nodular lesions, as well as air filled cavities varying in size as a presentation of the menstrual hemorrhage in the adjacent alveolar spaces. A greater number of such pulmonary lesions are generally identified in the right lung as compared to the left lung.
Please refer to
References: 1. Lee CH, Huang YC, Huang SF, Wu YK, et al. Thoracic endometriosis: rare presentation as a solitary pulmonary nodule with eccentric cavitations, Thorax. 2009;64:919–920
2. Hwang SM, Lee CW, Lee BS, Park JH, Clinical features of thoracic endometriosis: A single center analysis, Obstet Gynecol Sci. 2015;58(3):223-231
3. Chung SY, Kim SJ, Kim TH, Ryu WG, et al. Computed tomography findings of pathologically confirmed pulmonary parenchymal endometriosis. J Comput Assist Tomogr. 2005;29:815–8
Keywords: lung, endometriosis,

No. of Applicants : 77

▶ Correct Answer : 12/77, 15.6%

- The University of Kyoto Hospital , Japan TOMOAKI OTANI
- Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
- McGill University Health Center , Canada Alexandre Semionov
- Ondokuz Mayis University , Turkey CETIN CELENK
- Tiger Gate Hospital , Japan SHIN-ICHI CHO
- DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
- , Japan YASUSHI AOYAGI
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
- Inje University Pusan Paik Hospital , Korea (South) SUYOUNG YUN

▶ Correct Answer as Differential Diagnosis : 11/77, 14.3%

- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
- CH de la Cote Basque , France PAUL ARDILOUZE
- Chonnam National University Hospital , Korea (South) MOON GYEONG IL
- Other , Korea (South) MINSU KIM
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Chonnam National University Hospital , Korea (South) SEUNGYOON CHAE
- Toranomon Hospital , Japan KAORU SUMIDA
- Hamamatsu University Hospital , Japan YUKI HAYASHI
- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
- , Korea (South) HYUNGYU LEE

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1182 Date 2020-06-16

Discussion

No. of Applicants : 77