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Suwatanapongched T, Boonsarngsuk V, Amornputtisathaporn N, Leelachaikul P. Thoracic endometriosis with catamenial haemoptysis and pneumothorax: computed tomography findings and long-term follow-up after danazol treatment. Singapore Med J 2016; 56:e120-3. [PMID: 26243981 DOI: 10.11622/smedj.2015115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Thoracic endometriosis (TE) is an uncommon disorder affecting women of childbearing age. We herein report clinical and thin-section computed tomography (CT) findings of two cases, in which one woman presented with catamenial haemoptysis (CH) alone and another woman presented with bilateral catamenial pneumothoraces (CP) coinciding with CH, a rare manifestation of TE. The dynamic changes demonstrated on thin-section chest CT performed during and after menses led to accurate localisation and presumptive diagnosis of TE in both patients. Following danazol treatment, the patient with CH alone had a complete cure, while the patient with CP and CH had an incomplete cure and required long-term danazol treatment. We discuss the role of imaging studies in TE, with an emphasis on the appropriate timing and scanning technique of chest CT in women presenting with CH, potential mechanisms, treatment and patient outcomes.
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Affiliation(s)
- Thitiporn Suwatanapongched
- Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Viboon Boonsarngsuk
- Division of Pulmonary and Critical Care, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Naparat Amornputtisathaporn
- Division of Pulmonary and Critical Care, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paisan Leelachaikul
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Alwadhi S, Kohli S, Chaudhary B, Gehlot K. Thoracic Endometriosis-A Rare Cause of Haemoptysis. J Clin Diagn Res 2016; 10:TD01-2. [PMID: 27190915 DOI: 10.7860/jcdr/2016/16365.7530] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/09/2016] [Indexed: 11/24/2022]
Abstract
Thoracic endometriosis is a rare condition and occurs in females of reproductive age due to the presence of active endometrial tissue in tracheobronchial tree, lung parenchyma and lung pleura. A typical history of haemoptysis during menstrual periods and strong suspicion of the disease entity is important for the diagnosis and management of the case. Diagnosis of the disease is usually delayed. Serial CT thorax during menstrual period and in non-menstrual period supports the diagnosis. We present here a case of catamenial haemoptysis. The diagnosis was missed initially but later a detailed clinical history revealed the same. Serial computed tomography of thorax taken during menstrual and after menstrual period supported the diagnosis. Though bronchoscopy was able to reveal hyperemic tissue in the tracheobronchial tree, bronchial washing was inconclusive. The patient was treated successfully with danazol.
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Affiliation(s)
- Seema Alwadhi
- Specialist, Department of Radiodiagnosis, PGIMSR and ESI Hospital , Basaidarapur, New Delhi, India
| | - Supreethi Kohli
- Head and Senior, Specialist, Department of Radiodiagnosis, PGIMSR and ESI Hospital , Basaidarapur, New Delhi, India
| | - Bhupendra Chaudhary
- Senior Resident, Department of Radiodiagnosis, PGIMSR and ESI Hospital , Basaidarapur, New Delhi, India
| | - Kirti Gehlot
- Senior Resident, Department of Radiodiagnosis, PGIMSR and ESI Hospital , Basaidarapur, New Delhi, India
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53
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Albores J, Fishbein G, Bando J. A 34-Year-Old Woman With Recurrent Right-Sided Chest Pain and Dyspnea. Chest 2016; 148:e148-e151. [PMID: 26527442 DOI: 10.1378/chest.15-0813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A 34-year-old woman presented with her third episode of acute-onset right-sided chest pain and dyspnea. She had two prior similar occurrences of right-sided sharp, pleuritic chest pain with radiation to the back and dyspnea. Chest radiographs during these presentations revealed a small apical right-sided pneumothorax that was managed conservatively with high-flow oxygen. All three presentations were associated with vigorous exercise and the first day of her menses. She denied cough, hemoptysis, fever, smoking history, airplane travel, scuba diving, or trauma during these presentations. The patient has been trying to conceive for the past year but has been unsuccessful because of uterine fibroids but no history of endometriosis.
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Affiliation(s)
- Jeffrey Albores
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Gregory Fishbein
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Joanne Bando
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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54
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Rousset P, Gregory J, Rousset-Jablonski C, Hugon-Rodin J, Regnard JF, Chapron C, Coste J, Golfier F, Revel MP. MR diagnosis of diaphragmatic endometriosis. Eur Radiol 2016; 26:3968-3977. [PMID: 26868500 DOI: 10.1007/s00330-016-4226-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/05/2016] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate magnetic resonance imaging (MRI) for diaphragmatic endometriosis diagnosis. MATERIALS AND METHODS Over a 2-year period, all diaphragmatic MRI performed in the context of diaphragmatic endometriosis were reviewed. Axial and coronal fat-suppressed T1- and T2-weighted sequences were analyzed by two independent readers for the presence of nodules, plaque lesions, micronodule clustering, or focal liver herniation. MR abnormalities were correlated to surgical findings in women surgically treated. Interobserver agreement was assessed by κ statistics. RESULTS Twenty-three women with diaphragmatic endometriosis criteria comprised the population; 14 had surgical confirmation and nine had symptoms relief with hormonal treatment. MRI sensitivity was 83 % (19/23; 95 % confidence interval [CI]: 68, 98) for reader 1 and 78 % (18/23; 95 % CI: 61, 95) for reader 2. Kappa value was 0.86 (95 % CI: 0.47, 1.00). Readers 1 and 2 detected 35 and 36 lesions, respectively, all right-sided and agreed for 32 lesions on the type, location, and signal. Lesions were mostly nodules (23/32, 72 %), predominantly posterior (28/32, 87.5 %) and hyperintense on T1 (20/32, 63 %). MRI was negative for both readers in 2 surgically treated patients with small nodules or isolated diaphragmatic holes. CONCLUSION MRI allows diaphragmatic endometriosis diagnosis with 78 to 83 % sensitivity and excellent interobserver agreement. KEY POINTS • MRI allows the diagnosis of diaphragmatic endometriosis with up to 83 % sensitivity. • Diaphragmatic endometriosis lesions are better depicted on fat-suppressed T1-weighted sequences. • Diaphragmatic lesions, mostly hyperintense nodules, are right-sided and predominantly posterior. • MRI can help in timely diagnosis of diaphragmatic endometriosis.
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Affiliation(s)
- Pascal Rousset
- Lyon 1 Claude Bernard University, Villeurbanne, France. .,Radiology Department, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.
| | - Jules Gregory
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Biostatistics and Epidemiology department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Christine Rousset-Jablonski
- Obstetric and Gynecologic Department, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - Justine Hugon-Rodin
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Gynecology Endocrinology Department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Jean-François Regnard
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Thoracic Surgery Department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Charles Chapron
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Obstetric and Gynecologic Department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Joël Coste
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Biostatistics and Epidemiology department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - François Golfier
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Obstetric and Gynecologic Department, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - Marie-Pierre Revel
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Radiology Department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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de Paula MCF, Escuissato DL, Belém LC, Zanetti G, Souza AS, Hochhegger B, Nobre LF, Marchiori E. Focal pleural tumorlike conditions: nodules and masses beyond mesotheliomas and metastasis. Respir Med 2015; 109:1235-43. [PMID: 26094051 DOI: 10.1016/j.rmed.2015.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/07/2015] [Accepted: 06/08/2015] [Indexed: 12/11/2022]
Abstract
A tumorlike condition of the pleura is any nonmalignant lesion of the pleura or within the pleural space that could be confused with a pleural tumor on initial imaging. Tumorlike conditions of the pleura are relatively rare compared with neoplastic lesions such as mesotheliomas and metastases. Imaging-based diagnosis of these conditions can be difficult due to the similarity of appearance. Thus, recognition of certain imaging patterns and interpretation of these patterns in the clinical context are important. Pleural endometriosis, thoracic splenosis, thoracolithiasis, foreign bodies, pleural pseudotumors and pleural plaques are significant examples of focal tumorlike conditions discussed in this article. Computed tomography is the mainstay imaging technique for the primary assessment of pleural disease, but other imaging methods, such as magnetic resonance imaging and positron-emission tomography, can be of great support in the diagnosis.
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Affiliation(s)
| | | | | | - Gláucia Zanetti
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Bruno Hochhegger
- Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | | | - Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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56
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Elia S, De Felice L, Varvaras D, Sorrenti G, Mauriello A, Petrella G. Catamenial pneumothorax due to solitary localization of diaphragmatic endometriosis. Int J Surg Case Rep 2015; 12:19-22. [PMID: 25981153 PMCID: PMC4486100 DOI: 10.1016/j.ijscr.2015.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/27/2015] [Accepted: 05/04/2015] [Indexed: 11/19/2022] Open
Abstract
Catamenial pneumothorax is related to thoracic endometriosis syndrome. Diagnosis of catamenial pneumothorax is a difficult challenge and its treatment is controversial. We report a case of catamenial pneumothorax caused by a single diaphragmatic localization of thoracic endometriosis. Successful treatment consisted of combined video-assisted pleurodesis and postoperative hormonal therapy.
Introduction Catamenial pneumothorax (CP) is a spontaneous recurrent pneumothorax occurring in women in reproductive age. The etiology of CP has been associated with thoracic endometriosis and is its most common presentation. Presentation of case A case of right catamenial pneumothorax in a 38 year old woman is presented in which three episodes of CP occurred within 72 h of menses in a 6 month period. The patient underwent videothoracoscopy that revealed a solitary localization of diaphragmatic endometriosis. After surgical pleurodesis and based on final pathology of resected lesion, hormonal treatment was started. The outcome was uneventful and the patients is symptom-free at 6 months. Discussion Catamenial pneumothorax (CP) is a rare clinical entity characterized by lung collapse during menstruation, believed to be secondary to pleural endometriosis. Nearly all catamenial pneumothorax occur on the right side as pleural lesions are almost exclusively right-sided. Diagnostic imaging is based on high resolution computed tomography (HRCT) and, preferably, magnetic resonance imaging (MRI) since it is able to detect the blood products in the endometrial deposits. However the lack of macroscopic findings at surgery makes this condition still under-diagnosed. Based on the solitary diaphragmatic localization of endometriosis in our case we preferred to limit surgery to videothoracoscopic pleurodesis and start hormonal treatment with successful outcome. Conclusion Catamenial pneumothorax is the most common presentation of thoracic endometriosis syndrome and should always be suspected in women in childbearing age. Treatment option are still debated but best results are achieved by videothoracoscopic pleurodesis combined with hormonal therapy.
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Affiliation(s)
- Stefano Elia
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Italy.
| | - Laura De Felice
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Italy
| | - Dimitrios Varvaras
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Italy
| | - Giuseppe Sorrenti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | | | - Giuseppe Petrella
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Italy
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57
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Catamenial pneumothorax: a unique radiologic and intraoperative finding. Indian J Thorac Cardiovasc Surg 2015. [DOI: 10.1007/s12055-015-0366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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58
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Theunissen CIJM, IJpma FFA. Primary umbilical endometriosis: a cause of a painful umbilical nodule. J Surg Case Rep 2015; 2015:rjv025. [PMID: 25786440 PMCID: PMC4363684 DOI: 10.1093/jscr/rjv025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A female patient presented with a painful swelling in the umbilicus. Ultrasonography demonstrated a hypodense nodule of 1.8 cm. Surgical exploration revealed a subcutaneous, dark discoloured, lobulated swelling at the bottom of the umbilicus, which turned out to be primary umbilical endometriosis (PUE). Primary umbilical endometriosis is a rare and benign disorder, caused by the presence of ectopic endometrial tissue in the umbilicus, which can present as a painful, discoloured swelling in the umbilicus. The clinical distinction between primary umbilical endometrioses and other causes of an umbilical nodule is difficult. Additional imaging modalities do not show any pathognomonic signs for establishing this diagnose. Surgical exploration and excision are a safe and definitive treatment of primary umbilical endometrioses. This case highlights the importance of including PUE in the differential diagnosis of women with a painful umbilical nodule.
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Affiliation(s)
| | - Frank F A IJpma
- Department of Surgery, Isala Clinics, Zwolle, The Netherlands
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59
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Increased dose single-agent gemcitabine in platinum-taxane resistant metastatic ovarian cancer. TUMORI JOURNAL 2015; 101:36-40. [PMID: 25702671 DOI: 10.5301/je.5000209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/20/2022]
Abstract
CONCLUSION In platinum–taxane resistant epithelial ovarian cancer (EOC), we aimed to determine the effectiveness. PATIENTS AND METHODS Between 2004 and 2013, patients afflicted with platinum–taxane resistant EOC and who were administered a 30-minute i.v. infusion of single-agent gemcitabine at a dose of 1,250 mg/m2 on the 1st, 8th and 15th days, every 28 days, were examined retrospectively. RESULTS Twenty-six patients with platinum–taxane resistant EOC were included in the study. The overall survival (OS) was 48 months. The median survival after becoming platinum–taxane resistant was 16 months for the study population. Median time to progression (TTP) and median survival after becoming platinum–taxane resistant for patients who received second-line treatment were 3.3 months and 16 months, respectively; for patients who received third-line treatment with gemcitabine, these were 3.7 months and 19 months, respectively. Administration of gemcitabine as second- and third-line chemotherapy in platinum–taxane resistant EOC, provides similar TTP and OS outcomes (p = 0.4, p = 0.9) with a similar response and toxicity rate. CONCLUSIONS Second- and third-line gemcitabine at a dose of 1,250 mg/m2 on days 1, 8 and 15 every 28 days as a 30-minute i.v. infusion in platinum–taxane resistant EOC is an effective treatment option with a tolerable and manageable toxicity.
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60
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Rousset P, Revel MP. Re: Thoracic endometriosis syndrome: CT and MRI features. A reply. Clin Radiol 2014; 69:550. [DOI: 10.1016/j.crad.2014.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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Duyos I, López-Carrasco A, Hernández A, Zapardiel I, de Santiago J. Management of thoracic endometriosis: single institution experience. Eur J Obstet Gynecol Reprod Biol 2014; 178:56-9. [PMID: 24809986 DOI: 10.1016/j.ejogrb.2014.03.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Thoracic endometriosis is a relatively rare type of endometriosis and includes catamenial pneumothorax, hemothorax and hemoptysis, and presence of intrathoracic endometriotic nodules. We want to clarify and resume the most appropriate management of this pathology. STUDY DESIGN We retrospectively reviewed all the cases of thoracic endometriosis diagnosed and followed up in our Unit from 2005 to 2013. This search revealed five women, with a mean age of 34.5 (26-44). Four had previous history of endometriosis or severe dysmenorrhea. One patient complained of chronic shoulder pain with diaphragmatic implants, another one presented catamenial hemoptysis, and three women suffered from catamenial pneumothorax, with right-side preference. RESULTS Three patients underwent surgery and all of them were treated with GnRH agonists at least during 6 month referring improvement in symptoms. After 1-8 years follow-up, all these patients remain asymptomatic. CONCLUSION The optimal management of thoracic endometriosis needs further evaluation but the combined approach by hormonal therapy and surgery could be the best option.
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Affiliation(s)
- Inmaculada Duyos
- Gynecology Department, La Paz University Hospital, Madrid, Spain.
| | | | - Alicia Hernández
- Gynecology Department, La Paz University Hospital, Madrid, Spain
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Montoriol PF, Da Ines D, Bourdel N, Garcier JM, Canis M. Re: Thoracic endometriosis syndrome: CT and MRI features. Clin Radiol 2014; 69:549-50. [PMID: 24606834 DOI: 10.1016/j.crad.2014.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Affiliation(s)
| | - D Da Ines
- CHU Estaing, Clermont-Ferrand, France
| | - N Bourdel
- CHU Estaing, Clermont-Ferrand, France
| | | | - M Canis
- CHU Estaing, Clermont-Ferrand, France
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63
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Abstract
Thoracic endometriosis syndrome is the presence of endometrial tissue in or around the lung. Thoracic endometriosis syndrome consists of four distinct clinical entities: catamenial pneumothorax, catamenial hemothorax, hemoptysis, and pulmonary nodules. Thoracic endometriosis syndrome is a rare and complex condition, and diagnosis is often delayed or missed by clinicians, which can result in recurrent hospitalizations and other complications. Current treatments include hormone therapy and, where warranted, surgical intervention. We report the case of a 48-year-old woman with endometriosis causing bowel obstruction and concurrent catamenial pneumothorax.
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Affiliation(s)
| | - David Clarke
- Assistant Clinical Professor of Medicine at the Stanford University School of Medicine; a Consultant Physician in Internal Medicine at Dunedin Hospital in New Zealand; Honorary Clinical Senior Lecturer at the University of Otago School of Medicine in Dunedin, New Zealand; and a Hospitalist at the Santa Clara Medical Center in CA.
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