Pleural endometriosis: when to suspect?

Education and training, Diagnostic procedure, MR, CT, Conventional radiography, Thorax, Respiratory system Authors: C. S. Kiebert1, G. O. R. D. Rego1, Y. C. S. Neves2, D. Y. Otto1, L. P. Teixeira1, T. L. Matuki1, R. Guerrini1, M. V. Y. Sawamura1; 1São Paulo/BR, 2Salvador, Ba/BR DOI: 10.26044/ecr2019/C-2759 Learning objectives The purpose of this Educational Exhibit is to: To summarize the main features of thoracic endometriosis. To review radiological findings of pleural endometriosis in different exams, including chest radiography (CR), computed tomography (CT) and magnetic resonance imaging (MRI). To provide tips for radiologists to identify this often unexpected pathology and to help avoid late diagnosis.

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. The ectopic tissue is typically located in the pelvis, but endometriosis has been reported in almost all extrapelvic sites. The thoracic cavity is the most frequent extra-abdominopelvic site of endometriosis. The three main theories to explain thoracic endometriosis (TE) are (Figure 1): celomic pleural metaplasia in endometriosis tissue; retrograde menses reach the pleural cavity through the peritoneum and diaphragmatic defects; and lymphatic or hematogenous embolization of endometrial tissues. TEhas a wide variety... Findings and procedure details Radiological findings of PE: Chest radiograph (CR): Usually the initial exam. Normal or nonspecific findings such as: Pneumothorax; Pleural effusions; and Hemopneumothorax. Computed tomography (CT): Helpful in mapping the lesions and very useful in discarding other diagnoses. Usuallydepictsimplants as hypoattenuating nodules sometimes associated with an iso-attenuated component, depending on the size and blood content. Other findings include: Pneumothorax; Pleural effusions; Pleural adhesions; and Indirect signs of chronic pleural inflammation. Temporal changes in the size and morphological appearance of pleural or pulmonary nodules over the menstrual...

Pleural endometriosis is a rare condition and diagnosis can be quite challenging. It should be suspected in women of reproductive age with cyclical chest pain. Radiologists should recognize typical imaging findings to avoid a late diagnosis and implement appropriate treatment. Personal information Carolina S. Kiebert (Instituto de Radiologia do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil). Guilherme O. R. D. Rego (Instituto de Radiologia do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil). Yuri C. S. Neves (Instituto de Radiologia do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil). Deborah Y. Otto (Instituto de Radiologia do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil). Lívia P. Teixeira (Instituto de Radiologia do Hospital das Clínicas...

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