Chest ImagingEndometriosis, chest involvement
Endometriosis may rarely involve the chest in two different forms: pleurodiaphragmatic and bronchopulmonary. Pleurodiaphragmatic endometriosis presents clinically as either catamenial pneumothorax or less commonly as catamenial haemothorax.
Catamenial pneumothorax occurs only in relation to the menstruation, appearing 1 day before or up to 3 days after a period. The pneumothorax is usually small and self resolving. It is almost always right-sided. Recurrence is a characteristic feature and is prevented by pregnancy or drugs that suppress ovulation. Recurrent haemothorax occuring with the menstruation is right-sided, and related to pleural implantation of endometriosis after transdiaphragmatic spread.
Bronchopulmonary endometriosis induces catamenial haemoptysis. Pathologically, a focus of endometrial tissue is present in the lung parenchyma, and occasionally in a bronchus, together with a variable amount of parenchymal haemorrhage. Although the chest radiograph may be normal, the lesion often appears as a solitary pulmonary nodule, or as a thick-walled cavity with septations and focal mural irregularity. Sometimes the parenchymal bleeding is the dominant finding appearing as consolidation that goes and comes in phase with the menstruation and haemoptysis.
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