McCann Matthew R, Schenk William B, Nassar Aziza, Maimone Santo
Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA.
Department of Laboratory Medicine and Pathology, Mayo Clinic Florida, Jacksonville, FL, USA.
Radiol Case Rep. 2020 Jul 2;15(9):1419-1422. doi: 10.1016/j.radcr.2020.05.064. eCollection 2020 Sep.
Thoracic endometriosis is uncommon and may be overlooked, resulting in a delay in diagnosis. We describe the case of a 47-year-old woman presenting with acute onset pleuritic pain and hemothorax secondary to this rare entity. The diagnosis of thoracic endometriosis is driven by a compatible clinical history coupled with supportive imaging and immunohistochemical findings. Imaging features lack specificity, however, computed tomography and magnetic resonance imaging play an important role in identifying pleural/diaphragmatic involvement and excluding other more common diseases. Immunohistochemical pleural fluid analysis can confirm the presence of hormone receptor-positive endometrial glands and stroma. We illustrate a few potential diagnostic pitfalls, specifically the inconsistency in diagnostic yield of video-assisted thoracoscopic surgery/thoracentesis and the variable temporal association of patients' symptoms and pathology with menstruation. Prompt identification of thoracic endometriosis is important as it enables early institution of therapy and limits future complications.
胸段子宫内膜异位症并不常见，可能会被忽视，从而导致诊断延迟。我们描述了一例47岁女性患者，因这种罕见疾病出现急性发作的胸膜炎性胸痛和血胸。胸段子宫内膜异位症的诊断基于相符的临床病史以及支持性的影像学和免疫组化检查结果。影像学特征缺乏特异性，然而，计算机断层扫描和磁共振成像在识别胸膜/膈肌受累以及排除其他更常见疾病方面发挥着重要作用。免疫组化胸水分析可证实激素受体阳性的子宫内膜腺体和间质的存在。我们阐述了一些潜在的诊断陷阱，特别是电视辅助胸腔镜手术/胸腔穿刺术诊断率的不一致，以及患者症状和病理与月经的时间关联的变化。及时识别胸段子宫内膜异位症很重要，因为这样能够尽早开始治疗并减少未来的并发症。
