Successful Endoscopic Nd-YAG Laser Treatment of Endobronchial Endometriosis
October 22nd, 2014 by admin | Posted in Health Care
Catamenial hemoptysis is a rare condition that is associated with the presence of intrapulmonary or endobronchial endometrial tissue. Diagnosis of and therapy for this condition are still a matter of debate. We describe a case of endobronchial endometriosis with catamenial hemoptysis. An endobronchial lesion was diagnosed by spiral CT scan, taken at the onset of the menses, and confirmed with flexible bronchoscopy. The patient was successfully treated with endoscopic Nd-YAG laser therapy with a 1-day in-hospital procedure. We suggest that endoscopic laser treatment should be the first line of therapy for central airway endometriosis, provided that the source of bleeding has been conclusively located and all of the lesions can be reached with the bronchoscope.
Catamenial hemoptysis is a cyclic pulmonary hemorrhage that is synchronous with female menses. It is a rare clinical entity, associated with the presence of intrapulmonary ectopic endometrial tissue, and related both to distal parenchymal and to central airway lesions. Fewer than 40 cases of catamenial hemoptysis have been reported, although endometriosis related to trachea and/or large bronchi involvement is even rarer, with < 10 proven cases reported in the English literature.
Diagnosis of and therapy for this condition are still a matter of debate. The precise source of bleeding is generally not easy to localize because the chest radiograph, CT scan, and bronchoscopy often show normal findings after menses. Histopathologic confirmation of pulmonary endometriosis is also difficult since both biopsy and resected specimens should be obtained just before the onset of the menses. The main criterion for the diagnosis is the finding of periodic hemoptysis that is synchronous with menstruation, and most of the reported cases were diagnosed on the basis of the patient’s clinical history, without a supportive histologic demonstration.
A 25-year-old nonsmoking woman presented for evaluation of recurrent hemoptysis in July 2001. She underwent her first uneventful pregnancy, and the infant was delivered by a cesarean section in July 2000. In February 2001, just after the onset of menses, she suddenly expectorated roughly 10 mL red blood. Hemoptysis lasted for 1 day and stopped spontaneously. There were no other symptoms. Similar episodes occurred on the first day of every following menses until the time of evaluation. The volume of blood varied from 5 to 15 mL. The findings of a chest radiograph and flexible fiberoptic bronchoscopy, which were performed elsewhere in June 2001, were normal.