Revista portuguesa de cirurgia cardio-toracica e vascular : orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular · 2017
What About Having a Hydropneumothorax Every Month?
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Lopes Sara, Maciel João, Cabral Bastos Pedro, Pinho Paulo
Аннотация
INTRODUCTION: Endometriosis is a pathological, benign, inflammatory condition characterized by the presence of endometrial glands and stroma outside the uterine cavity, typically in the pelvis. In rare conditions, this estrogen-dependent disease may be extrapelvic, presenting with a variety of symptoms, including Thoracic Endometriosis.
METHODS: A 37 year-old woman presented with her third right hydropneumothorax in three months. Her medical history included infertility, an ovarian mass (in study), biliary diskinesia and protein C deficiency. The CT showed a bleb in the right inferior lobe and a pleural effusion. A detailed clinical history revealed a temporal relationship of the hydropneumothoraxes and her menses.
RESULTS: She underwent a videothoracoscopy: there were macroscopic tissue alterations all over the parietal and visceral pleura. We performed a biopsy of one of those spots (of the parietal pleura) and an atypical resection of the apex of the apical segment of the right inferior lobe, where the bleb was. A talc pleurodesis was also performed. The patient was discharged at day 1 and is currently under regular follow-up in ambulatory, with no recurrent pneumothoraxes for two months. The histopathology was compatible with a pleural Endometriosis.
CONCLUSION: Thoracic endometriosis is a clinical diagnosis, although the histopathologic confirmation is preferred (but not necessary): it should be suspected in reproductive age women who present with hemothorax, pneumothorax, hemoptysis, chest or scapular pain, lung nodules or diaphragmatic rupture perimenstrually, especially right-sided. Most commonly it presents as catamenial pneumothorax and/or hemothorax. Those with high clinical suspicion and/ or imaging supportive of the diagnosis, should undergo an interventional procedure (thoracoscopy), both for diagnose and management. Primary treatment is chest tube drainage. Prevention of recurrence can be medical (hormonal suppression) or surgical (lung resection, pleurectomy, pleurodesis).
METHODS: A 37 year-old woman presented with her third right hydropneumothorax in three months. Her medical history included infertility, an ovarian mass (in study), biliary diskinesia and protein C deficiency. The CT showed a bleb in the right inferior lobe and a pleural effusion. A detailed clinical history revealed a temporal relationship of the hydropneumothoraxes and her menses.
RESULTS: She underwent a videothoracoscopy: there were macroscopic tissue alterations all over the parietal and visceral pleura. We performed a biopsy of one of those spots (of the parietal pleura) and an atypical resection of the apex of the apical segment of the right inferior lobe, where the bleb was. A talc pleurodesis was also performed. The patient was discharged at day 1 and is currently under regular follow-up in ambulatory, with no recurrent pneumothoraxes for two months. The histopathology was compatible with a pleural Endometriosis.
CONCLUSION: Thoracic endometriosis is a clinical diagnosis, although the histopathologic confirmation is preferred (but not necessary): it should be suspected in reproductive age women who present with hemothorax, pneumothorax, hemoptysis, chest or scapular pain, lung nodules or diaphragmatic rupture perimenstrually, especially right-sided. Most commonly it presents as catamenial pneumothorax and/or hemothorax. Those with high clinical suspicion and/ or imaging supportive of the diagnosis, should undergo an interventional procedure (thoracoscopy), both for diagnose and management. Primary treatment is chest tube drainage. Prevention of recurrence can be medical (hormonal suppression) or surgical (lung resection, pleurectomy, pleurodesis).