Hassanein Mahmoud Farouk Kamel, Herminie Venessa, James Nuhu Teri, Chetty Danisela
Department of Internal Medicine, Seychelles Hospital, Healthcare Agency, Victoria, Seychelles.
Department of Obstetrics and Gynaecology, Seychelles Hospital, Healthcare Agency, Victoria, Seychelles.
Eur J Case Rep Intern Med. 2024 Jul 1;11(8):004613. doi: 10.12890/2024_004613. eCollection 2024.
Haemorrhagic pleural effusion can be a challenging diagnosis that requires a thorough investigation and sometimes a multidisciplinary team of physicians to reach the underlying aetiology. Causes can include pulmonary malignancy, pulmonary infections, connective tissue diseases, asbestos associated, intra-abdominal conditions such as pancreatitis and ovarian tumours, cardiovascular disorders such as ruptured aneurysms and pulmonary infarction, as well as other miscellaneous causes. One such cause is endometriosis in the thoracic cavity. Endometriosis is a chronic illness associated with the occurrence of endometrial tissue outside the endometrium. Insertion of endometrial tissue in the thoracic cavity is rare, with only a few cases described. This case report gives detail of a 30-year-old nulligravida suspected of having thoracic endometriosis following a history of catamenial dyspnoea and associated pleural effusion. The diagnosis was confirmed through the histopathological study of tissue obtained via thoracoscopic surgery. Excision of the endometrial tissue was done, and the patient then continued medical treatment with progestins and gonadotrophin-releasing hormone (GnRH) agonists. Following therapy, the index patient was asymptomatic. A multidisciplinary approach is often needed in the diagnosis and management of thoracic endometriosis, involving both medical and surgical specialities. Minimally invasive surgery is the gold standard of diagnosis, allowing for direct visualisation of implants and nodules and should be followed by medical treatment to reduce the risk of recurrence. Medical therapy alone is associated with higher rates of recurrence. Physicians must have a high degree of suspicion as thoracic endometriosis is a disease that can often be missed.
Thoracic endometriosis syndrome is a rare but significant cause of haemorrhagic pleural effusion in women of childbearing age.Diagnosis and treatment can be challenging, and a multidisciplinary approach has been found to improve outcomes.
出血性胸腔积液的诊断可能具有挑战性，需要进行全面检查，有时还需要多学科医生团队来找出潜在病因。病因可包括肺部恶性肿瘤、肺部感染、结缔组织病、石棉相关疾病、腹腔疾病（如胰腺炎和卵巢肿瘤）、心血管疾病（如动脉瘤破裂和肺梗死）以及其他各种病因。其中一个病因是胸腔内子宫内膜异位症。子宫内膜异位症是一种与子宫内膜组织在子宫内膜外出现相关的慢性疾病。子宫内膜组织在胸腔内植入很少见，仅有少数病例报道。本病例报告详细介绍了一名30岁未孕女性，她在有经期呼吸困难和相关胸腔积液病史后被怀疑患有胸腔子宫内膜异位症。通过胸腔镜手术获取组织的组织病理学研究证实了诊断。切除了子宫内膜组织，然后患者继续接受孕激素和促性腺激素释放激素（GnRH）激动剂的药物治疗。治疗后，该患者无症状。胸腔子宫内膜异位症的诊断和管理通常需要多学科方法，涉及医学和外科专业。微创手术是诊断的金标准，可直接观察植入物和结节，随后应进行药物治疗以降低复发风险。单纯药物治疗复发率较高。医生必须高度怀疑，因为胸腔子宫内膜异位症是一种常被漏诊的疾病。
胸腔子宫内膜异位症综合征是育龄女性出血性胸腔积液的罕见但重要病因。诊断和治疗可能具有挑战性，多学科方法已被证明可改善治疗效果。
