Xiaoli, an 18-year-old freshman, has been coughing up blood in recent days, and the amount of blood is still quite large, which frightens her. Since it was coughing up blood, the first thing that came to mind was definitely the problem of the lungs, so I came to our hospital for treatment. After carefully asking the patient's medical history, the most common cause of coughing up blood is nothing more than tuberculosis, bronchiectasis, and malignant tumors. Young so light, the possibility of tumor is very small, will it be tuberculosis? Tuberculosis now spreads in colleges and universities. Whatever the reason, a routine chest CT is a must.
CT shows a regularly morphologically hollow shadow of about 2.2 cm in diameter in the lower lobe of the right lung, with a smooth wall surrounded by a ground glass density shadow. Not like bronchiectasis, nor less like tuberculosis. Admitted to the hospital for further examination. During the hospitalization, a full set of tuberculosis-related examinations, sputum examinations, and bronchoscopy were prepared. On the fourth day of the round, Xiaoli said that she had completely coughed up blood and did not want to do a tracheoscope. And mentioned a strange phenomenon, the last time I coughed up blood was during menstruation, this time too, how can it be so coincidental. The last time I coughed up a small amount of blood, I took some medicine just fine, and I didn't take it seriously.
The phenomenon she inadvertently mentioned immediately reminded me of a disease, endometriosis. The next day, the patient's menstrual period passed, let the patient review the chest CT, the original hollow shadow can not be seen at all, very magical. This further validates my judgment. Later, the patient went to see a gynecologist and was diagnosed with endometriosis.
Endometriosis, as the name suggests, is a function of endometriosis to other parts and organs. It occurs most often in the pelvic, ovarian, and peritoneum, but also in the large intestine, appendix, and abdominal wall scars of caesarean section, and occurs rarely in the lungs.
Endometriosis in the lungs, also known as menstrual lung disease, is the endometrium "running" to the lungs or bronchi, with the menstrual cycle and changes, menstrual period, the endometrium of this place will also appear peeling and cause bleeding, menstruation is over, the bleeding lesions of the lungs will stop active, bleeding stops. At present, the cause of the disease is not clear, there are "menstrual reflux theory" and "body cavity epithelial metaplasia theory".
Endometriosis in the lungs is more common in young and middle-aged women, and patients present symptoms such as hemoptysis and chest pain, which are closely related to the menstrual cycle, and there is no specificity on the image and various forms. There are pneumonia-like shadows of parenchymal infiltrates, well-defined isolated nodules or cystic-like shadows, or cystic-like changes containing fluid levels, and even bronchial obstruction and peripheral atelectasis.
Therefore, when women during the reproductive period recurrent hemoptysis, cough, and hemothoracinia related to the menstrual cycle, the possibility of endometriosis in the lungs should be considered after excluding other lung diseases. In patients with endometriosis, in addition to ectopic to the lungs, she often has ectopic lesions in the pelvic cavity, which will show dysmenorrhea, menstrual disorders, and infertility. Endometriosis to the ovaries can cause chocolate cysts to grow on the ovaries.
How should menstrual lung disease be treated?
drug therapy
From the first day of menstruation, continuously take short-acting contraceptives for 3-6 months, so that the estrogen level in the body remains in a stable state, the endometrium is atrophied, and the lung lesions can be reduced and even cured.
Surgical treatment
Surgical removal of ectopic lesions in the lungs may be considered in patients with failed medications, intolerable adverse drug reactions, or recurrent episodes of symptoms.