Lung Endometriosis

Pulmonary Endometriosis (Thoracic Endometriosis) – A Comprehensive Guide

What is Pulmonary Endometriosis?

Pulmonary endometriosis is a rare form of endometriosis characterized by the presence of endometrial tissue within the thoracic cavity, particularly on the surfaces of the lungs and pleura. It is considered part of the thoracic endometriosis syndrome.

How Does It Occur?

It develops when endometrial cells reach the thoracic region via retrograde menstruation, lymphatic, or hematological spread. It is often associated with advanced-stage pelvic endometriosis.

Symptoms

The most typical findings are catamenial (menstruation-related) chest pain, shortness of breath, and cough. Catamenial pneumothorax and hemoptysis (bloody sputum) may occur.

Catamenial Pneumothorax

Recurrent lung collapse (pneumothorax) during menstruation is the most common clinical form of thoracic endometriosis and usually occurs on the right side.

How Is It Diagnosed?

Diagnosis often begins with clinical suspicion. Thoracic CT, MRI, and video-assisted thoracoscopy (VATS) are helpful in diagnosis. Definitive diagnosis is often made surgically.

Imaging Findings

Pleural nodules, diaphragmatic defects, and lesions in the lung parenchyma may be seen on CT and MRI. However, small lesions may be missed.

Treatment Approach

Treatment is divided into medical and surgical approaches. While hormonal therapies can reduce symptoms, surgical treatment involves the excision of lesions.

Surgical Treatment

Video-assisted thoracoscopic surgery (VATS) can be used to remove lesions and repair diaphragmatic defects. A multidisciplinary approach is important.

Medical Treatment

GnRH analogs, progestins, and combined hormonal therapies provide symptom control, but recurrence may occur.

Clinical Significance

Pulmonary endometriosis can often be overlooked. It should definitely be considered in women with a history of menstruation-related chest pain or pneumothorax.

Conclusion

Thoracic endometriosis is a rare condition that can lead to serious complications. With early diagnosis and appropriate treatment, it can be successfully managed.