Rare case of Thoracic Endometriosis reported in NEJM

Thoracic Endometriosis is a rare and complex condition therefore diagnosis is often delayed or missed by clinicians. In order to avoid such issues and implement appropriate treatment, a high index of suspicion is essential in any woman of reproductive age or receiving hormone replacement therapy who is experiencing cyclical chest pain, dyspnea, and/or hemoptysis. As far as treatment is concerned, Hormone therapy is a suitable first-line treatment because it is less invasive and can preserve fertility. However, surgical intervention is available for women for whom medical therapy fails or who have a high burden of disease.

According to history, a 26-year-old woman presented to the emergency department with an episode of coughing up blood. During the previous 4 years, she had had intermittent episodes of small-volume hemoptysis coinciding with her menstrual cycles. She had no other abdominal or pelvic symptoms. Her oxygen saturation was 100% while she was breathing ambient air. On physical examination, the lungs were clear. Noncontrast computed tomography (CT) of the chest on the third day of her menstrual cycle showed an 11-mm ground-glass, cavitary nodule in the right lower lobe (Panel A, arrow). A video-assisted thoracoscopic wedge resection was performed, and a reddish-brown lesion was identified. Histopathological analysis revealed endometrial glands and stroma (Panel B), which confirmed a diagnosis of thoracic endometriosis. Catamenial hemoptysis is a rare manifestation of thoracic endometriosis, and both CT and histopathological examination are important for diagnosis. At a follow-up visit 2 years after resection, the patient was symptom-free.