{"paper_id":"db9ac598-5e1c-4da7-a6fc-b0eb357fe929","body_text":"Practice CMAJ\nE758 CMAJ, August 9, 2011, 183(11) © 2011 Canadian Medical Association or its licensors \nA\n44-year-old woman presented to hos -\npital with a 10-day history of hemop -\ntysis. Her medical history included \nendometriosis and an ovarian cystectomy six \nyears previously. Her hemoptysis coincided \nwith her current menstrual period. She had no \nhistory of weight or appetite change, and was a \nnonsmoker. She was afebrile, with a normal \nblood leukocyte count. Chest radiography \nshowed two nodules in the right lower lobe ( Fig -\nure 1 ), and computed tomography of the chest \nshowed multiple cavitary nodules bilaterally \nwith a left-sided pneumothorax (Appendix 1 ,\navailable at www.cmaj .ca /lookup/suppl \n/doi:10.1503/cmaj.100804/-/DC1). Although it \nis rare, we suspected thoracic endometriosis \nbased on the patient’s history and clinical pre -\nsentation, but we could not exclude malig -\nnancy or granulomatous disease. We decided \nto proceed with video-assisted thoracoscopic \nsurgery (VATS) to obtain tissue for pathologic \nexamination. We removed a nodule from the \nleft lung, and pathologic examination showed \nabundant endometrial glands and stroma \n(Appendix 2, available at www.cmaj .ca \n/lookup/suppl/doi:10.1503/cmaj.100804/-/DC1 ), \nconsistent with thoracic endometriosis. The \npatient declined hormonal therapy because of \nconcerns about long-term adverse effects. \nThree months later, we resected several nodules \nfrom her right lung. The patient’s postoperative \ncourse was uneventful, and she remained free \nof hemoptysis during five months of follow-up. \nThoracic endometriosis may involve the tra -\nchea, bronchi, lung parenchyma, pleura or \ndiaphragm. The presentation typically includes \npneumothorax, hemoptysis, a lung mass or a \ncombination of the above. Most instances occur \nin the third and fourth decades of life, and the \nright hemithorax is more often affected than the \nleft side. 1 Chest radiography is often normal but \nmay show solitary or multiple pulmonary nod -\nules, which change in size during the menstrual \ncycle. Computed tomography is more sensitive \nthan plain radiography for diagnosis of pul -\nmonary endometriosis. 2 The treatment of pul -\nmonary endometriosis may be medical or sur -\ngical. Although medical treatment involving \ngonadotropin-releasing hormone agonists has \nbeen recommended as the first line in treatment \nof extrapelvic endometriosis, 3 preliminary evi -\ndence based on small case series suggests that \nlung resection using VATS for periodic hemop -\ntysis occurring at the time of menstruation can \nalso be effective. 4,5 \nReferences \n1. Carter EJ , Ettensohn DB . Catamenial pneumothorax. Chest \n1990 ;98 :713 -6.\n2. Ciudad MJ , Santamaría N, Bustos A, et al. Imaging findings in \ncatamenial pneumothorax. Radiologia 2007;49:263-7. \n3. Practice Bulletin No. 114: management of endometriosis. Obstet \nGynecol 2010 ;116 :223 -36 .\n4. Inoue T, Kurokawa Y, Kaiwa Y, et al. Video-assisted thoraco -\nscopic surgery for catamenial hemoptysis. Chest 2001; 120: \n655-8. \n5. Kim CJ, Nam HS, Lee CY, et al. Catamenial hemoptysis: a \nnationwide analysis in Korea. Respiration 2010;79:296-301. \nClinical images \nThoracic endometriosis \nYen-Sung Lin MD, Chih-Yen Tu MD \nCompeting interests: None \ndeclared. \nThis article has been peer \nreviewed. \nAffiliations: From the \nDivision of Pulmonary and \nCritical Care Medicine (Lin, \nTu), Department of Internal \nMedicine, China Medical \nUniversity Hospital; and the \nDepartment of Life Sciences \n(Tu), National Chung Hsing \nUniversity, Taiwan, China \nCorrespondence to: \nDr. Chih-Yen Tu, \nchesttu@gmail.com \nCMAJ 2011. DOI:10.1503 \n/cmaj.100804 \nFigure 1: Chest radiograph (cropped) of a 44-year-old woman with hemoptysis \nshowing two nodules (arrows) over the right lung.","source_license":"CC0","license_restricted":false}