Diagnosis of Pulmonary Endometriosis by Bronchoalveolar Lavage

Thoracic endometriosis is an uncommon clinical entity known to produce several types of pleuropulmonary complications, including catamenial pneumothorax, hemotho-rax, catamenial hemoptysis, and solitary pulmonary nodules. Catamenial hemoptysis may result from pulmonary parenchy-mal endometriosis or endometriosis of the tracheobronchial mucosa. A case of a 29-year-old woman with recurrent catamenial hemoptysis of approximately 1 year's duration is described. She also had documentation of pelvic endometriosis. The clinical suspicion was that she had pulmonary endometriosis with catamenial hemoptysis. During menses, her chest roentgenogram was negative. A high-resolution computed tomographic scan of the thorax revealed a 1.5 cm triangular patchy area of infiltrate in the lingula peripherally. A bronchoscopy revealed small amounts of old blood in both bronchial trees without active bleeding. No mucosal lesions were identified. A diagnostic bronchoalveolar lavage demonstrated presence of clusters of endometrial cells. The cytologic features of endometriosis found in the bronchoalveolar lavage specimen indicated that this bronchoscopic technique may be helpful in the definitive documentation of pulmonary parenchymal endometriosis.