From the Research
The initial workup for a patient suspected of having pulmonary endometriosis should include a thorough clinical history focusing on catamenial symptoms, physical examination, chest imaging, and possibly endocrine testing, as recommended by the most recent and highest quality study 1. The diagnosis of pulmonary endometriosis is often challenging due to its rarity and similarity to other respiratory conditions.
- Key symptoms to inquire about include catamenial hemoptysis, chest pain, or dyspnea that correlates with menstrual cycles, as these are hallmark symptoms of the condition.
- High-resolution chest CT is the preferred imaging modality, ideally performed during menstruation when lesions are most apparent, and may reveal ground-glass opacities, nodules, or bullae 2.
- Pulmonary function tests should be conducted to assess lung function and identify any restrictive or obstructive patterns.
- Laboratory tests should include complete blood count, hormone levels (estrogen, progesterone), and CA-125 (which may be elevated) 3.
- Bronchoscopy with bronchoalveolar lavage may be performed during menstruation to identify hemosiderin-laden macrophages or endometrial cells.
- In some cases, video-assisted thoracoscopic surgery (VATS) with biopsy may be necessary for definitive diagnosis, as reported in a case study 4. This comprehensive approach is essential because pulmonary endometriosis is rare and can mimic other respiratory conditions, making clinical correlation with the menstrual cycle crucial for accurate diagnosis, as highlighted in a systematic review of 202 studies 1.