Catamenial hemoptysis: A case report of pulmonary endometriosis

We report a case of a patient diagnosed with pulmonary endometriosis and successfully treated with a GnRH agonist. This 34-year-old mother presented cyclic hemoptysis since 4-month. A non-enhanced computed tomography made at the end of the luteal phase revealed a solitary lung nodule with no other abnormalities. A contrast enhanced computed tomography conducted during menses revealed a ground glass opacity extending from the nodule towards hilum. The diagnosis of pulmonary endometriosis was established taking into account the clinical presentation and the imaging findings. Medical treatment by Triptorelin pamoate (Decapeptyl LP® 3 mg Ipsen Pharma, France), a GnRH agonist, was proposed for a period of 6 months. A CT scan performed 3 months after the end of the treatment shows a complete disappearance of the endometriosis nodular lesion.

Case report of pulmonary endometriosis and review of the literature

Pulmonary endometriosis is a rare form of thoracic endometriosis. We herein describe a 29-year-old woman with recurrent hemoptysis associated with her menstrual cycle. The patient had a 4-month history of catamenial hemoptysis without thoracic pain, respiratory embarrassment, cough, fever, night sweating, or loss of appetite. Chest computed tomography revealed exudation shadows in the right lower pulmonary lobe and small fiber lesions in the right middle lobe and left lung. Thoracoscopic wedge resection of the right lower pulmonary lobe was performed, and the pathological result was pulmonary endometriosis. No evidence of hemoptysis during menstruation was found following the operation.

Relationship between Catamenial Pneumothorax or Non-catamenial Pneumothorax and Endometriosis

STUDY OBJECTIVE

To evaluate the clinical characteristics of women presenting with catamenial pneumothorax and compare them with those with noncatamenial pneumothorax.

DESIGN

A case-control study (Canadian Task Force II-2).

SETTING

A multicenter study.

PATIENTS

Forty-two women with pneumothorax: 21 women had catamenial pneumothorax (study group), and 21 were age-matched women with noncatamenial pneumothorax (control group).

INTERVENTIONS

All patients underwent video-assisted thoracoscopy and pleural biopsy. We also evaluated the presence and stage of pelvic endometriosis in 16 women with catamenial pneumothorax who had undergone laparoscopic surgery.

MEASUREMENTS AND MAIN RESULTS

The number of known episodes of catamenial pneumothorax before treatment was between 2 and 8 episodes. Symptoms were mainly chest pain and shortness of breath; 1 patient had hemoptysis. The prevalence of right-sided pneumothorax was 95.2% in the study group and 57.1% in the control group (p = .004). Besides 2 cases with complete collapse of the right lung, most of the cases in the study group had apical pneumothorax. Pelvic endometriosis was found in 15 of 16 women (93.7%), mainly stage 3 or 4, and thoracic endometriosis in 12 of 20 women (60%). None of the patients in the control group had thoracic endometriosis.

CONCLUSION

Thoracic endometriosis is found in over half of women with catamenial pneumothorax but absent in those with noncatamenial pneumothorax. Right apical pneumothorax is predominant in women with catamenial pneumothorax. Endometriosis plays an important role in the mechanism of catamenial pneumothorax.