Chetambath Ravindran, Kumar Praveen, Nandini V, Chandran Shilpa, Chacko Anju
Department of Pulmonology, Baby Memorial Hospital, Kozhikode, Kerala, India.
Lung India. 2023 Nov-Dec;40(6):541-544. doi: 10.4103/lungindia.lungindia_144_23.
Common causes of haemorrhagic pleural effusions include malignancy (primary or metastatic), tuberculosis, pulmonary embolism, collagen vascular diseases, trauma and iatrogenic causes. Clinical history along with pathologic, microbiologic and biochemical evaluation of pleural fluid confirms the diagnosis in most cases. However, if there is recurrent haemorrhagic effusion without corroborative history or mass lesion in lung, or evidence of microorganisms, then we should think of uncommon causes. Catamenial haemothorax (CHt) is a rare cause of haemorrhagic pleural effusion, which recurs during each menstrual cycle. This is a manifestation of thoracic endometriosis syndrome (TES) caused by ectopic endometrial tissue in the thoracic cavity in women of child-bearing age. This extremely rare condition is difficult to diagnose, unless direct correlation with the menstrual cycle is established. TES consists of pleural forms such as catamenial pneumothorax, non-catamenial endometriosis-related pneumothorax and haemothorax; and parenchymal forms such as catamenial haemoptysis and lung nodules. Here we report a case of CHt in a 43-year-old female whose diagnosis was established by thoracoscopic pleural biopsy.
血性胸腔积液的常见病因包括恶性肿瘤（原发性或转移性）、肺结核、肺栓塞、胶原血管疾病、创伤和医源性原因。在大多数情况下，结合临床病史以及对胸腔积液进行病理、微生物学和生化评估可确诊。然而，如果出现反复的血性胸腔积液，且无相应病史或肺部占位性病变，也无微生物学证据，那么我们应考虑罕见病因。月经性血胸（CHt）是血性胸腔积液的一种罕见病因，在每个月经周期都会复发。这是育龄期女性胸腔内异位子宫内膜组织引起的胸腔子宫内膜异位症综合征（TES）的一种表现。这种极为罕见的病症很难诊断，除非能确定其与月经周期有直接关联。TES包括胸膜形式，如月经性气胸、非月经性子宫内膜异位症相关气胸和血胸；以及实质形式，如月经性咯血和肺结节。在此，我们报告一例43岁女性的CHt病例，其诊断通过胸腔镜胸膜活检得以确立。
