Tuberc Respir Dis.  2008 Jul;65(1):29-33. 10.4046/trd.2008.65.1.29.

Catamenial Hemoptysis Treated by Video-assisted Thoracoscopic Surgery

• Cho CB
• Kim DG
• Kim C
• Park JY
• Lee SW
• Jang SH
• Jung KS
• Jun SY
• Lee JW

• KMID: 1478213
• DOI: http://doi.org/10.4046/trd.2008.65.1.29

Abstract

Catamenial hemoptysis is a rare condition that's characterized by recurrent hemoptysis occurring in association with menstruation, and this is associated with the presence of intrapulmonary or endobronchial endometrial tissue. The diagnosis of pulmonary endometriosis can be made according to a typical clinical history and with exclusion of other causes of recurrent hemoptysis. Treatment of pulmonary endometriosis can be medical or surgical; however, the optimal management of this condition is still a matter of debate. Medical therapy may be problematic, due to recurrence of symptoms despite hormonal ablation, and adverse effects from long-term hormone therapy can also be a problem. We report here on a case of pulmonary endometriosis in a 23-year-old woman who presented with hemoptysis that occurred during the first 3 days of menstruation, and this happened over a 4 month period. She was successfully treated by video-assisted thoracoscopic surgery (VATS). No more hemoptysis was noted during 12 months of follow-up.

Keyword

Catamenial hemoptysis; Pulmonary endometriosis; Video-assisted thoracoscopic surgery (VATS)

MeSH Terms

Endometriosis
Female
Follow-Up Studies
Hemoptysis
Humans
Menstruation
Recurrence
Thoracic Surgery, Video-Assisted
Young Adult

Figure

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  Figure 1 Preoperative chest x-ray shows no abnormal finding.

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  Figure 2 A chest HRCT image obtained during the patient's menstrual period shows consolidation and ground glass opacity at the lateral and posterior basal segment of right lower lobe (A). 2 months later, the other chest CT image shows aggravation of consolidation and ground glass opacity at the same segments (B).

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  Figure 3 Engorged blood vessels were noted in the right lower lobar bronchus (A). 2 months later, a small amount of fresh blood was coming out from the basal segment of the right lower lobe (B, C).

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  Figure 4 A lobectomy specimen of right lower lung, measuring 15×10×5 cm, reveals a pooly-demarcated hemorrhagic mass (4×3.5×1.5 cm), 10 cm apart from the bronchial resection margin (A). Microscopically, there is extensive intraalveolar hemorrhage with congested dilated vessels (H&E stain, ×40) (B). In the hemorrhagic alveolar spaces, many hemosiderin-laden macrophages (arrows) are seen (H&E stain, ×400) (C).

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