Thoracic endometriosis

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Thoracic endometriosis is a rare form of endometriosis where endometrial-like tissue is found in the lung parenchyma and/or the pleura. It can be classified as either pulmonary, or pleural, respectively. [1] Endometriosis is characterized by the presence of tissue from the lining of the uterus (the endometrium) forming abnormal growths elsewhere in the body. Usually these growths are found in the pelvis, between the rectum and the uterus, the ligaments of the pelvis, the bladder, the ovaries, and the sigmoid colon. The cause is not known. The most common symptom of thoracic endometriosis is chest pain occurring right before or during menstruation. Diagnosis is based on clinical history and examination, augmented with X-ray, CT scan, and magnetic resonance imaging of the chest. Treatment options include surgery and hormones.

Endometriosis disease of the female reproductive system characterized by the growth of endometrial tissue outside the uterine body

Endometriosis is a condition in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside of it. Most often this is on the ovaries, fallopian tubes, and tissue around the uterus and ovaries; however, in rare cases it may also occur in other parts of the body. The main symptoms are pelvic pain and infertility. Nearly half of those affected have chronic pelvic pain, while in 70% pain occurs during menstruation. Pain during sexual intercourse is also common. Infertility occurs in up to half of women affected. Less common symptoms include urinary or bowel symptoms. About 25% of women have no symptoms. Endometriosis can have both social and psychological effects.

Lung Essential respiration organ in many air-breathing animals

The lungs are the primary organs of the respiratory system in humans and many other animals including a few fish and some snails. In mammals and most other vertebrates, two lungs are located near the backbone on either side of the heart. Their function in the respiratory system is to extract oxygen from the atmosphere and transfer it into the bloodstream, and to release carbon dioxide from the bloodstream into the atmosphere, in a process of gas exchange. Respiration is driven by different muscular systems in different species. Mammals, reptiles and birds use their different muscles to support and foster breathing. In early tetrapods, air was driven into the lungs by the pharyngeal muscles via buccal pumping, a mechanism still seen in amphibians. In humans, the main muscle of respiration that drives breathing is the diaphragm. The lungs also provide airflow that makes vocal sounds including human speech possible.

Uterus major female hormone-responsive reproductive sex organ of most mammals including humans

The uterus or womb is a major female hormone-responsive secondary sex organ of the reproductive system in humans and most other mammals. In the human, the lower end of the uterus, the cervix, opens into the vagina, while the upper end, the fundus, is connected to the fallopian tubes. It is within the uterus that the fetus develops during gestation. In the human embryo, the uterus develops from the paramesonephric ducts which fuse into the single organ known as a simplex uterus. The uterus has different forms in many other animals and in some it exists as two separate uteri known as a duplex uterus.

Contents

Signs and symptoms

Thoracic endometriosis is characterised by onset of the following clinical symptoms within 24 hours prior to and 72 hours after onset of menses.

Catamenial pneumothorax

Catamenial pneumothorax is a condition of air leaking into the pleural space (pneumothorax) occurring in conjunction with menstrual periods, believed to be caused primarily by endometriosis of the pleura.

Pneumothorax Abnormal collection of air in the pleural space that causes an uncoupling of the lung from the chest wall

A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases the amount of air in the chest increases when a one-way valve is formed by an area of damaged tissue, leading to a tension pneumothorax. This condition can cause a steadily worsening oxygen shortage and low blood pressure. Unless reversed by effective treatment, it can result in death. Very rarely both lungs may be affected by a pneumothorax. It is often called a collapsed lung, although that term may also refer to atelectasis.

Chest pain discomfort or pain felt anywhere along the front of the body between the neck and upper abdomen

Chest pain is discomfort, typically in the front of the chest. It may be described as sharp, dull, pressure, heaviness, or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, or nausea, sweating, or shortness of breath. It can be divided into heart-related and non heart related pain. Pain due to insufficient blood flow to the heart is also called angina pectoris. Those with diabetes or who are old may have less clear symptoms.

A women thoracic endometriosis and also have dysmenorrhoea and irregular menses. [4]

Complications

Pneumothorax and haemothorax are rarely life-threatening. The most common complication is progressive tissue damage or scarring related to inflammation, and in extremely rare cases malignant transformation of the endometrial-like tissue. [1]

Cause

The cause of thoracic endometriosis is unknown. [5] Those with previous surgeries are more prone to developing thoracic endometriosis due to the surgical manipulation that can cause embolisation of the endometrial tissue into the thoracic cavity. Some thoracic endometriosis patients have been described as having a congenital defect in the diaphragm. There is also an association between thoracic and pelvic endometriosis.[ medical citation needed ]

Pathophysiology

The endometrium, the tissue that normally lines the female uterus, undergoes changes with each menstrual cycle. At the end of each cycle and after the lining has thickened in preparation for hosting a fertilised ovum, it sloughs off, detaches, and is expelled through the cervix and vagina in the process of menstruation. In endometriosis, some endometrial-like tissue is found in other parts of the body; most often the pelvis and abdomen, the central nervous system, the nasal passages, skin and thorax. At these other 'ectopic' sites, endometrium tissue still responds to hormones with normal cyclical changes - bleeding roughly every 28 days.[ medical citation needed ]

Theories explaining distant ectopic endometriosis include:

A review of autopsy data showed that patients with endometriosis have bilateral pulmonary lesions, which supports the vascular embolisation theory. The pleural and/or diaphragmatic lesions were always found on the left side, which supports the theory of coelomic metaplasia.[ medical citation needed ]

Diagnosis

The diagnosis of thoracic endometriosis is primarily based on clinical history and examination, augmented with non-invasive studies such as X-ray, CT scan, and magnetic resonance imaging of the chest. Pelvic ultrasound is also useful to determine if the patient has any degree of pelvic or abdominal endometriosis (indicated by the presence of free fluid). More invasive methods for obtaining a tissue diagnosis of thoracic endometriosis include video thoracoscopy (for pleural or pulmonary biopsy), or bronchoscopy (for pulmonary or bronchial biopsy, or bronchial lavage). [2] A case series has been reported in which clinical diagnosis was made in 50% of patients, the rest being diagnosed either via biopsy (25%) or bronchoalveolar lavage (25%).[ citation needed ]

Treatment

Definitive diagnosis is necessary to avoid unnecessary treatment and exclude more serious diagnoses (for example, haemoptysis, pleural effusion or cancer. Overall treatment for pulmonary endometriosis is surgical, with subsegmentectomy. Preserving lung parenchyma is a priority while removing macroscopic signs of pathological tissue. [5] Medical treatment can include the use of gonadotropin-releasing hormone analogues, which can cause cessation of menstruation. Side effects of this treatment can be decreased libido, as well as a 50% recurrence rate. [8] [9] Even in the asymptomatic, treatment is recommended to prevent possible complications listed above.[ medical citation needed ]

Epidemiology

Thoracic endometriosis affects women aged 15–54, who are between menarche and menopause. It can affect their qualify of life, with catamenial pneumothorax being the most common presentation. [1]

Related Research Articles

Endometrium inner mucous membrane of the mammalian uterus

The endometrium is the inner epithelial layer, along with its mucous membrane, of the mammalian uterus. It has a basal layer and a functional layer; the functional layer thickens and then is shed during menstruation in humans and some other mammals, including apes, Old World monkeys, some species of bat, and the elephant shrew. In most other mammals, the endometrium is reabsorbed in the estrous cycle. During pregnancy, the glands and blood vessels in the endometrium further increase in size and number. Vascular spaces fuse and become interconnected, forming the placenta, which supplies oxygen and nutrition to the embryo and fetus. The speculated presence of an endometrial microbiota has been argued against.

Pleural cavity thin fluid-filled space between the two pulmonary pleurae (visceral and parietal) of each lung

The pleural cavity also known as the pleural space, is the thin fluid-filled space between the two pulmonary pleurae of each lung. A pleura is a serous membrane which folds back onto itself to form a two-layered membranous pleural sac. The outer pleura is attached to the chest wall, but is separated from it by the endothoracic fascia. The inner pleura covers the lungs and adjoining structures, including blood vessels, bronchi and nerves. The pleural cavity can be viewed as a potential space because the two pleurae adhere to each other under all normal conditions. Parietal pleura projects up to 2.5 cm above the junction of the middle and medial third of the clavicle

Gynecologic hemorrhage represents excessive bleeding of the female reproductive system. Such bleeding could be visible or external, namely bleeding from the vagina, or it could be internal into the pelvic cavity or form a hematoma. Normal menstruation is not considered a gynecologic hemorrhage, as it is not excessive. Hemorrhage associated with a pregnant state or during delivery is an obstetrical hemorrhage.

Pleurisy pleural disease that is characterized by swelling, due to inflammation of the pleura, the lining of the pleural cavity surrounding the lung or lungs.

Pleurisy, also known as pleuritis, is inflammation of the membranes that surround the lungs and line the chest cavity (pleurae). This can result in a sharp chest pain while breathing. Occasionally the pain may be a constant dull ache. Other symptoms may include shortness of breath, cough, fever or weight loss, depending on the underlying cause.

Adenomyosis

Adenomyosis is a gynecologic medical condition characterized by the abnormal presence of endometrial tissue within the myometrium. When endometrial tissue is present abnormally entirely outside the uterus, it is considered to be a similar but distinct medical condition, endometriosis. The two conditions are found together in many cases, but often occur separately. Before being recognized as a distinct condition, adenomyosis was called endometriosis interna. The less-commonly-used term "adenomyometritis" is a more specific name for the condition, specifying involvement of the uterus.

Vaginal bleeding is any bleeding through the vagina, including bleeding from the vaginal wall itself, as well as bleeding from another location of the female reproductive system, often the uterus. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding. Vaginal bleeding may occur at any age, but always needs investigation when encountered in children or in postmenopausal women. Vaginal bleeding during pregnancy may indicate a possible pregnancy complication that needs to be medically addressed.

Pulmonary sequestration congenital disorder of respiratory system

A pulmonary sequestration is a medical condition wherein a piece of tissue that ultimately develops into lung tissue is not attached to the pulmonary arterial blood supply, as is the case in normally developing lung. This sequestered tissue is therefore not connected to the normal bronchial airway architecture, and fails to function in, and contribute to, respiration of the organism.

Hemothorax Blood accumulation in the pleural cavity

A hemothorax is an accumulation of blood within the pleural cavity. The symptoms of a hemothorax include chest pain and difficulty breathing, while the clinical signs include reduced breath sounds on the affected side and a rapid heart rate. Hemothoraces are usually caused by an injury but may occur spontaneously: due to cancer invading the pleural cavity, as a result of a blood clotting disorder, as an unusual manifestation of endometriosis, in response to a collapsed lung, or rarely in association with other conditions.

Endometritis inflammation of inner lining of uterus

Endometritis is inflammation of the inner lining of the uterus (endometrium). Symptoms may include fever, lower abdominal pain, and abnormal vaginal bleeding or discharge. It is the most common cause of infection after childbirth. It is also part of spectrum of diseases that make up pelvic inflammatory disease.

Subcutaneous emphysema Surgical Emphysema

Subcutaneous emphysema is when gas or air is in the layer under the skin. Subcutaneous refers to the tissue beneath the skin, and emphysema refers to trapped air. Since the air generally comes from the chest cavity, subcutaneous emphysema usually occurs on the chest, neck and face, where it is able to travel from the chest cavity along the fascia. Subcutaneous emphysema has a characteristic crackling feel to the touch, a sensation that has been described as similar to touching Rice Krispies; this sensation of air under the skin is known as subcutaneous crepitation.

Plural disease occurs in the pleural space, which is the thin fluid-filled area in between the two pulmonary pleurae in the human body, there are several disorders that can occur

Ovarian diseases are conditions that happen to young women and can affect their reproductive system and general health.

Fibrothorax

Fibrothorax is a medical condition characterised by scarring (fibrosis) of the pleural space surrounding the lungs that is severe enough to cause reduced movement of the lung and ribcage. The main symptom of fibrothorax is shortness of breath. There also may be recurrent pleural effusions. Fibrothorax may occur as a complication of many diseases, including infection of the pleural space known as an empyema or bleeding into the pleural space known as a haemothorax. Fibrosis in the pleura may be produced intentionally using a technique called pleurodesis to prevent recurrent punctured lung or pneumothorax, and the usually limited fibrosis that this produces can rarely be extensive enough to lead to fibrothorax. The condition is most often diagnosed using an X-ray or CT scan, the latter easier to detect in mild cases. Fibrothorax is often treated conservatively with watchful waiting but may require surgery. The outlook is usually good as long as there is no underlying pulmonary fibrosis or complications following surgery. The disease is highly uncommon.

Endometrioma Human disease

Endometrioma is the presence of endometrial tissue in and sometimes on the ovary. It is the most common form of endometriosis. More broadly, endometriosis is the presence of endometrial tissue located outside the uterus. The presence of endometriosis can result in the formation of scar tissue, adhesions and an inflammatory reaction. It is a benign growth. An endometrioma is most often found in the ovary. It can also develop in the cul-de-sac, the surface of the uterus, and between the vagina and rectum.

Chronic pulmonary aspergillosis (CPA) is a long-term aspergillus infection of the lung and Aspergillus fumigatus is almost always the species responsible for this illness. Patients fall into several groups as listed below.

Tumor-like disorders of the lung pleura are a group of conditions that on initial radiological studies might be confused with malignant lesions. Radiologists must be aware of these conditions in order to avoid misdiagnosing patients. Examples of such lesions are: pleural plaques, thoracic splenosis, catamenial pneumothorax, pleural pseudotumor, diffuse pleural thickening, diffuse pulmonary lymphangiomatosis and Erdheim-Chester Disease.

Asbestos-related diseases disorder of the lung and pleura caused by the inhalation of asbestos fibres

Asbestos-related diseases are disorders of the lung and pleura caused by the inhalation of asbestos fibres. Asbestos-related diseases include non-malignant disorders such as asbestosis, diffuse pleural thickening, pleural plaques, pleural effusion, rounded atelectasis and malignancies such as lung cancer and malignant mesothelioma.

References

  1. 1 2 3 Rojas, J. (2014). Endometriosis pulmonar parenquimal. Rev Soc Peru Med Interna, 27(1).
  2. 1 2 3 4 Alifano, M. (n.d.). Thoracic Endometriosis: Current Knowledge. Retrieved July 7, 2016, from http://www.annalsthoracicsurgery.org/article/S0003-4975(05)01322-6/fulltext?refuid=S0003-4975(11)02531-8&refissn=0003-4975
  3. McGraw-Hill Medical| AccessMedicine | McGraw-Hill Medical http://accessmedicine.mhmedical.com/content.aspx bookid=331
  4. U.S National Library of Medicine https://www.nlm.nih.gov/medlineplus/spanish/ency/article/000915.htm
  5. 1 2 Endometriosis pulmonar torácica: presentación de 2 casos de una enfermedad muy poco frecuente | Archivos de Bronconeumología http://www.archbronconeumol.org/es/thoracic-pulmonary-endometriosis-two-reports/articulo/S030028961300358X/
  6. Laschke MW, Giebels C, Menger MD (2011). "Vasculogenesis: a new piece of the endometriosis puzzle". Hum. Reprod. Update. 17 (5): 628–36. doi:10.1093/humupd/dmr023. PMID   21586449.
  7. 1 2 3 Endometriosis parenquimatosa pulmonar multifocal.Patologia, 262-266
  8. http://www.elsevier.es/es-revista-progresos-obstetricia-ginecologia-151-articulo-neumotorax-catamenial-recurrente-13067055
  9. Korean J Obstet Gynecol. 2012 Dec;55(12):1031-1034. Korean. Published online Dec 18, 2012. https://dx.doi.org/10.5468/KJOG.2012.55.12.1031