Catamenial hemoptysis and pneumothorax in a patient with cystic fibrosis.
Hemoptysis or pneumothorax that recurs with the onset of menses is strongly suggestive of thoracic endometriosis syndrome (TES). TES is a rare disorder, with relatively few cases reported in the literature. A 32-year-old woman with cystic fibrosis, who over a period of several months had experienced recurrent catamenial hemoptysis and pneumothoraces, including an episode of life-threatening hemoptysis that coincided with menstruation, is presented. Thoracic computed tomography and magnetic resonance imaging scans, as well as a bronchoscopic evaluation that demonstrated endobronchial lesions that disappeared after menses, support the diagnosis of TES in the present patient. The patient was treated empirically with danazol and subsequently underwent a successful double-lung transplantation. Danazol was discontinued postoperatively, and she was started on an oral contraceptive. Eighteen months post-transplant, she has not experienced a recurrence of her catamenial symptoms, despite having resumed a regular menstrual cycle.
Parker
Chris M
CM
Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, Ontario, Canada. parkerc@post.queensu.ca
Nolan
Robert
R
Lougheed
M Diane
MD
D000328:Adult; D003550:Cystic Fibrosis / Q000150:complications*; D003613:Danazol / Q000627:therapeutic use; D004715:Endometriosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D006469:Hemoptysis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D016040:Lung Transplantation / Q000379:methods; D008598:Menstruation; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013577:Syndrome; D016896:Treatment Outcome
D004965:Estrogen Antagonists; D003613:Danazol
Respir Med. 2007 May;101(5):1032-6
17011769
Chest. 2003 Sep;124(3):1004-8
12970030
Chest. 2003 Sep;124(3):1168-70
12970053
J Thorac Cardiovasc Surg. 2004 May;127(5):1513-4
15116017
Obstet Gynecol. 1975 Aug;46(2):147-54
125397
N Engl J Med. 1993 Jun 17;328(24):1759-69
8110213
Thorax. 1993 Oct;48(10):1048-9
8256237
Am J Med. 1996 Feb;100(2):164-70
8629650
Ann Thorac Surg. 2006 Feb;81(2):761-9
16427904
Respirology. 2006 May;11(3):348-50
16635098
Thorax. 2003 Jan;58(1):89-90
12511729
Ann Thorac Surg. 2006 Aug;82(2):726-9
16863799