[Pleuropulmonary endometriosis]

Endometriosis is a condition where endometrial and cytogenic chorion glands lie outside the uterine cavity. The underlying pathophysiological mechanisms remain unclear. Pelvic localizations are common, but more distant localizations in cutaneous, neurological or thoracic sites are exceptional. Symptoms following the menstrual cycle suggest the diagnosis. Bronchopulmonary endometriosis is exceptional. The diagnosis is suggested by the presence of recurrent hemoptysis following the menstrual cycle. Distal lesions are exceptionally visible to the endoscope. Chest x-ray and CT can visualize the lesion as a nodule with variable size depending on the menstrual cycle. Positive diagnosis is obtained at excision. The characteristic feature of catamenial pneumothorax is recurrent pneumothorax in the fourth decade of life, almost always on the right and coincident with menses but with no other signs. The diagnosis is clinical and radiological. Endometriomas appear as hypodense nodules on CT scan if they are larger than one centimeter. A homogeneous hypersignal is seen on the MRI. Thoracoscopy or thoracotomy may be necessary; the endopleural aspect is specific. The hypothesized pathogenic mechanism involves an air passage from the genital tract via breaches in the diaphragm. Treatment is based on medical or surgical pleural synthesis and hormone therapy for several months.