Channabasavaiah Anitha D, Joseph Jose Vempilly
From UCSF Fresno, Division of Pulmonary & Critical Care Medicine, Fresno, California.
Medicine (Baltimore). 2010 May;89(3):183-188. doi: 10.1097/MD.0b013e3181df67d5.
Thoracic endometriosis (TE) is a rare disorder affecting women during their reproductive years. The etiopathogenesis of this disease is not well understood; the prevailing opinion is based on analysis obtained from case reports and small case series. A 1996 review of TE was not able to address the association between clinical presentation and thoracic pathology due to a paucity of thoracoscopic findings in these earlier cases. Since the year 2001, most published cases and series have included thoracoscopic findings. Therefore, we compiled data from case reports and case series published in English from January 2001 to July 2007 to analyze the demographics, clinical characteristics, and thoracoscopic findings, and to study the relationship between thoracoscopic findings and clinical presentation in patients with thoracic endometriosis. The clinical presentations in 110 patients were as follows: pneumothorax in 79 (72%), hemoptysis in 16 (14%), hemothorax in 13 (12%), and lung mass in 2 (2%). Ninety-one of the 110 (85%) patients underwent thoracotomy or thoracoscopy. The right hemithorax was more often affected (85%) than the left side (p = 0.008). The mean (standard deviation [SD]) age of all patients was 34 (7.6 yr). The mean age of patients presenting with hemoptysis (25.9 +/- 4.6 yr) was significantly lower than the age of those presenting with pneumothorax and hemothorax (p < 0.01). There was no significant association between the presence of diaphragmatic defects and pneumothorax (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.05-1.58; p = 0.23). The presence of parietal and visceral pleural implants was associated with a fivefold increase in hemothorax (OR, 5.55; 95% CI, 1.20-25.53; p < 0.01).Hemoptysis occurring in younger subjects may be the earliest manifestation of parenchymal lung involvement in TE. Diaphragmatic defects do not increase the risk for pneumothorax. Hemothorax reflects an increased burden of pleural implants in TE.
胸段子宫内膜异位症（TE）是一种在育龄期女性中较为罕见的疾病。该病的病因发病机制尚未完全明确；目前的主流观点是基于病例报告和小病例系列分析得出的。1996年对TE的综述由于早期病例中胸腔镜检查结果较少，未能探讨临床表现与胸部病理之间的关联。自2001年以来，大多数已发表的病例和系列研究都包含了胸腔镜检查结果。因此，我们收集了2001年1月至2007年7月以英文发表的病例报告和病例系列中的数据，以分析人口统计学特征、临床特点和胸腔镜检查结果，并研究胸段子宫内膜异位症患者胸腔镜检查结果与临床表现之间的关系。110例患者的临床表现如下：气胸79例（72%），咯血16例（14%），血胸13例（12%），肺部肿块2例（2%）。110例患者中有91例（85%）接受了开胸手术或胸腔镜检查。右侧胸腔受累更为常见（85%），高于左侧（p = 0.008）。所有患者的平均（标准差[SD]）年龄为34岁（7.6岁）。咯血患者的平均年龄（25.9±4.6岁）显著低于气胸和血胸患者（p < 0.01）。膈肌缺损的存在与气胸之间无显著关联（优势比[OR]，0.3；95%置信区间[CI]，0.05 - 1.58；p = 0.23）。壁层和脏层胸膜植入物的存在与血胸增加五倍相关（OR，5.55；95% CI，1.20 - 25.53；p < 0.01）。年轻患者出现咯血可能是胸段子宫内膜异位症实质肺受累的最早表现。膈肌缺损不会增加气胸风险。血胸反映了胸段子宫内膜异位症中胸膜植入物负担的增加。
