Thoracic endometriosis: a case report and literature review

Abstract

pleural thickening might also be diagnosed on the basis of CT scans.Compared with pulmonary actinomycosis, the bacteriologic diagnosis is easily obtained by means of thoracocentesis in case of pleural involvement. However, diagnosis might be obscured by previous antibiotic therapy and a lack of anaerobic conditions for culture. At direct microbiologic examination, actinomycosis has to be suspected if gram-positive filamentous germs are discovered. An anaerobic enriched environment is needed for appropriate culture.Penicillin G still remains the drug of choice, and the mainstay of treatment is the administration of high-dose intravenous penicillin. Eighteen to 24 millions units of penicillin per day are given for 2 to 6 weeks, followed by oral penicillin V administration for another 6 to 12 months. The evolution should be monitored by use of plain radiographs or CT.In stage I empyema, indication for surgical intervention is uncommon, but the efficacy of antibiotic therapy depends on the onset of diagnosis. If the treatment is delayed, stage II and III empyemas can develop, and decortication is required. Chest-wall fistulization has to be resected during the intervention. A VATS approach is usually unrewarding because of the chronicity of empyema at the time of the operation. After the operation, penicillin administration is recommended.

Thoracic Endometriosis Syndrome

“…It is a rare disorder characterized by the presence of functional endometrial tissue within the pleura, the lung parenchyma or the airways [8]. In a review of 65 cases of thoracic endometriosis, 54 cases were pleural and only 11 cases were characterized as parenchymal [9].…”

“…Two different theories have been proposed. Ivanoff’s metaplasia theory postulates that the pleura which develop in the coleomic cavity in utero may undergo metaplasia to form pleural endometrial tissue [8]. A second theory is the retrograde menstruation with transdiaphragmatic passage and subsequent implantation of the stromal and glandular elements of endometrium in the thoracic cavity [8, 9].…”

“…They suggested a model in which the expansion of intraparenchymal subpleural endometriotic tissue during menses would cause a check valve airway obstruction, eventually leading to alveolar rupture. High levels of serum prostaglandin causing vasospasm and bronchospasm during menses may also augment alveolar rupture in lung areas with intraparenchymal endometriosis, resulting in pneumothorax [8, 18]. Furthermore, adhesions caused by endometrial tissue involving the pleura, the lung parenchyma or the chest wall create a situation in which minor increases in intrathoracic pressure may create barotrauma.…”

“…The X-ray in pulmonary endometriosis may reveal pleural effusion or nodular opacities, but often may be normal. Chest computed tomography (CT) findings include opacities, nodular lesions, thin-walled cavities and bullous formations [8]. Chest CT scan or magnetic resonance imaging, however, should be performed during menses for maximal diagnostic sensitivity [32].…”

“…The lesions disappear after menses, and a crypt can be observed as a sign of the cysts’ healing. Surgery is frequently needed to establish the diagnosis, and more than 60% of affected patients require thoracotomy or thoracoscopy as part of the diagnostic approach [8]. Histopathologic confirmation of pulmonary endometriosis is also difficult since both biopsy and resected specimens should be obtained just before the onset of menses [34].…”