Thoracic endometriosis presented as catamental hemoptysis: a case series of a rare disease

Abstract

Objective

Thoracic endometriosis syndrome (TES) is a rare disease in which a functioning endometrial tissue is observed in the pleura, lung, parenchyma, airways, and/or diaphragm. The optimal management of this disease remains a matter of debate. We aimed to report TES cases and their effective hormonal treatment and management.

Methods

In this retrospective study, women presented as catamenial hemoptysis (CH) diagnosed with thoracic endometriosis were included. The main outcome of measure was cessation or recurrence of the clinical manifestations of thoracic endometriosis.

Results

The mean onset age of the 14 patients was 30.21 ± 5.40 years. CH was characteristic symptom of these patients. All patients underwent chest computed tomography (CT) scan during menstruation and 2 or 3 weeks after menstruation, which showed the obvious shrinking or disappearance of the lesions. All of the patients were given Gonadotropin releasing hormone agonists (GnRHa) for 3 to 6 months, eleven of them were administered with combined oral contraceptives (COC) cyclically after GnRHa. The median follow-up duration was 24 months. Hemoptysis recurrence was observed in one patient.

Conclusions

CH is a rare clinical entity of thoracic endometriosis, the change of CT images during and after menstruation or the response to GnRHa were helpful for accurate diagnosis. Hormonal treatment with GnRHa followed by COCs cyclically could be employed for efficient management of thoracic endometriosis.

Keywords:

• Catamenial hemoptysis
• COC
• GnRHa hormonal treatment
• thoracic endometriosis

Data availability statement

The data that support the findings of this study are available from the corresponding author, [JL], upon reasonable request.

Transparency

Declaration of funding

National Key R&D Program of China: 2017YFC1001200.

Declaration of financial/other relationships

The authors declare that they have no competing interests. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

J-H. L is the guarantor of the article and takes responsibility for the content of the manuscript, and approved the final version. Y. D contributed substantially to conception and design analysis, integrity of the data and accuracy of the analysis, drafted the article, and revised the final version. M-H L, Y-S W and B L contributed substantially to data and material collection. J-H. Lang and Y-J L contributed substantially to conception and design and approved the final version of the article. Z-Y Z contributed substantially to conception and design and approved the final version to be published. All authors read and approved the final version to be published.

Acknowledgements

The authors acknowledge Dr Anuradha Nalli (PhD) and Dr Amit Bhat (PhD) (Indegene, Bangalore, India) for providing language help in the development of this manuscript.

Ethical approval and consent to participate

This study protocol was approved by the Institutional Review Board (IRB) of PUMCH (IRB no. JS-1532). All patients received information on the purpose and conduct of this study, and provided written, informed consent.