What is Thoracic Endometriosis ?

Thoracic endometriosis is a rare form of endometriosis where endometrial tissue is found in the lung parenchyma and/or the pleura.Thoracic endometriosis syndrome consists of four distinct clinical entities : catamenial pneumothorax, catamenial hemothorax, hemoptysis, and pulmonary nodules.

What caused Thoracic Endometriosis ?

The cause of thoracic endometriosis is unknown.Those with previous surgeries are more prone to developing thoracic endometriosis due to the surgical manipulation that can cause embolisation of the endometrial tissue into the thoracic cavity. Some thoracic endometriosis patients have been described as having a congenital defect in the diaphragm. There is also an association between thoracic and pelvic endometriosis.

Thoracic Endometriosis Symptoms

Thoracic endometriosis is characterised by onset of the following clinical symptoms within 24 hours prior to and 72 hours after onset of menses.

• Catamenial pneumothorax : this is the most common clinical manifestation, present in 80% of cases. Catamenial pneumothorax is defined as a recurrent pneumothorax that occurs within the first 72 hours after menstruation. It may not necessarily occur with every menstrual cycle and in most cases is one-sided and on the right side. There are cases of catamenial pneumothorax on the left side, and on very rare occasions there may be a bilateral catamenial pneumothorax. Symptoms are the same as for other types of pneumothorax: chest pain, cough and breathlessness. Symptoms are usually mild but there may be severe presentations.

• Catamenial hemothorax : this is a rare manifestation of thoracic endometriosis, occurring in 14% of cases. In almost all cases, the right side is affected but has been one case of a bilateral catamenial hemothorax documented. The most common presenting symptoms are nonspecific and include cough, chest pain and shortness of breath. In some cases, signs may mimic pulmonary embolism. The quantity of blood loss varies, but severe anemia is possible. In almost all cases, chest x-ray shows the presence of pleural effusion without specific characteristics. A CT scan may show additional features such as nodular lesions of the pleura, multiloculated effusions, or bulky pleural masses.

• Cyclic haemoptysis : haemoptysis during menstruation is extremely rare, with about 30 case reports in medical literature.[3] Currently, there have been no reports of massive haemoptysis or death. Cyclic haemoptysis is a sign of pulmonary parenchymal endometriosis; ectopic endometrial tissue in the lung responds to cyclical hormonal variation, bleeding along with the normal endometrium located in the uterus.

• Pulmonary nodules : nodules are common radiological features in patients with thoracic endometriosis; most cases are associated with catamenial haemoptysis.

• Dysmenorrhoea and irregular menses

Thoracic Endometriosis Treatment Options

1.Surgical Treatment.

2.Hormonal therapy.

3.Pain relieve.

4.Endometriosis Herbal Treatment

Surgery will help removing macroscopic signs of pathological tissue, but laparoscopy is a relatively but not absolutely safe operation. There are risks and complications during and after the surgery. During procedure, complications include uncontrolled bleeding, damage to organs such as bowel. After surgery, it is likely to cause wound infection, uterus infection.

Hormone treatment works to block or reduce the estrogens production of body and put woman into an artificial pregnancy state or menopausal state, making endometriosis unable to continue growing and helping to relieve symptoms. Oral contraceptives and vaginal rings are usually used to control hormone. Please note that this therapy has no effect on adhesions and the endometriosis may return if you stop the treatment.

Medical treatment can include the use of gonadotropin-releasing hormone analogues, which can cause cessation of menstruation. Side effects of this treatment can be decreased libido, as well as a 50% recurrence rate.

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