Pulmonary Endometriosis at An Unexpected Site Found with CT Scanning: A Case Report and Literature Review

- 期刊 肺實質性的子宮內膜異位症是非常少見引起咳血的原因之一，更帶給了臨床醫師在確定診治上的困擾。至今只有50個零星病例在英文文獻中被報告，但其中只有l/3的病人是經由病理組織報告來確定診斷。在此，我們報告一位17歲的女性病人以週期性的咳血來表現。經過一系列的檢查後，胸部電腦斷層顯示在左下葉有一塊疑似發炎的病兆。為了確定診斷及後續治療，我們利用一個新的定位工具－雙棘角線圈定位後施行胸腔內視鏡楔狀切取手術。術中意外於左上葉發現數個瘀血狀的病兆。最後的病理組織報告顯示在意外發現的左上葉病兆中有完整的異位性子宮內膜組織而在電腦斷層顯示的左下葉病兆中只有出血的病理變化。在本文中，我們詳細地探討了關於肺部子宮內膜異位症併發經期性咳血的診斷、治療及在手術中意外發現了術前電腦斷層未診斷出來的子宮內膜異位病兆的可能原因。 Parenchymal pulmonary endometriosis is an extremely rare cause of hemoptysis and poses a diagnostic problem to clinicians. Only 50 cases have been reported in the English literature since the first published case. All of the reported cases have been attributed to pulmonary endometriosis, although less than one-third of them have had histologic evidence. We report the case of a 17-year-old female with a history of an induced abortion. She presented with periodic hemoptysis occurring in the 2 days prior to menstruation over a 6-month period. A series of studies were done, but only the chest CT revealed sub-segmental ground-glass attenuation in the left lung, suggesting an inflammatory process. Due to the uncertain etiology, she underwent emplacement of a double-thorn hook wire, localization under CT-guidance, and a wedge resection of the left lung lesion using video-assisted thoracic surgery (VATS). Incidentally, we found some ecchymosis patches on the left lingular lobe, which were not found on the chest CT, and those were resected, as well. The histopathologic examination revealed ectopic endometrial tissue on the specimen of the lingula, but only a fresh hemorrhage on the left lower lobe. She was treated with danazol due to the hemoptysis recurring 3 months later. No recurrence of hemoptysis was noted in 6 months of follow-up. The approach to diagnosis and treatment of pulmonary endometriosis is reviewed and the inconsistency of the chest CT and VATS findings is discussed.