Endometriose torácica

 

Filipa Costa ¹

Fernando Matos ²

 

Resumo

A endometriose torácica define-se pela presença de tecido endometrial no pulmão ou pleura e manifesta-se clinicamente por hemoptises cíclicas, pneumotórax ou hemotórax recorrente coincidentes com a menstruação. Tratando-se de uma patologia rara, nem sempre é considerada no diagnóstico diferencial quando se avaliam estas manifestações. Os exames complementares de diagnóstico geralmente não revelam alterações específicas, sendo o diagnóstico feito com base na história clínica. A chave do diagnóstico são os sintomas catameniais, sendo fundamental realizar uma história clínica minuciosa para chegar atempadamente ao diagnóstico correcto. O tratamento hormonal e a cirurgia são as duas alternativas terapêuticas para esta patologia.

Os autores descrevem o caso clínico de uma doente de 27 anos que surge com um quadro de hemoptises catameniais. Os exames complementares de diagnóstico realizados foram inconclusivos. Baseado na história clínica, assumiu-se o diagnóstico de endometriose pulmonar e iniciou-se tratamento com contraceptivos orais com resolução total dos sintomas.

A propósito do caso clínico, os autores fazem uma revisão das principais manifestações clínicas, da patogénese, do diagnóstico e do tratamento da endometriose torácica.

Palavras-chave: Endometriose torácica, endometriose pulmonar, endometriose pleural, hemoptises, pneumotórax, hemotórax, catamenial.

 

 

Thoracic endometriosis

Thoracic endometriosis is defined by the presence of endometrial tissue in the lungs or pleura, and is characterised by cyclic hemoptysis or recurrent hemothorax or pneumothorax occurring with the menstruation. Being a rare clinical entity, it is not always considered in the differential diagnosis when these symptoms are evaluated. The exams performed during the diagnostic work-up frequently show nonspecific alterations, however a presumptive diagnosis can be made based on the typical clinical history. The key to the diagnosis are the catamenial symptoms, so a thorough clinical history is essential to promptly reach the correct diagnosis. Hormonal treatment and surgery are the two mainstays of therapy for this pathology.

The authors present the case of a 27 year-old female patient presenting with cyclic hemoptysis during the menstruation. The diagnostic workup was inconclusive. Based on the clinical history, the diagnosis of pulmonary endometriosis was assumed and treatment was initiated with oral contraceptives with total resolution of symptoms.

The authors make a brief review of the main symptoms, pathogenesis, diagnosis and treatment of thoracic endometriosis.

Key-words: Thoracic endometriosis, pulmonary endometriosis, pleural endometriosis, hemoptysis, pneumothorax, hemothorax, catamenial.

 

 

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1 Interna do Internato Complementar de Pneumologia

2 Assistente Hospitalar Graduado de Pneumologia

Serviço de Pneumologia

Centro Hospitalar de Coimbra

(Director: Dr. Jorge Pires)

Quinta dos Vales

São Martinho do Bispo

3046-853 Coimbra

 

Recebido para publicação/received for publication: 07.12.20