Catamenial hemoptysis from tracheobronchial endometriosis - Reappraisal ofdiagnostic value of bronchoscopy and bronchial brush cytology

Objectives: To analyze the clinical data of four patients with a diagnosis of tracheobronchial endometriosis, and to reappraise the diagnostic value o f bronchoscopy and bronchial brush cytology in these patients. Methods: We conducted a retrospective study of four patients with documente d tracheobronchial endometriosis treated at National Taiwan University Hosp ital from 1994 to 1998. The complete histories, diagnostic time interval, r esults of physical examinations, laboratory data, bronchoscopic findings, c ytologic results, chest radiographs, and chest CT of these patients were an alyzed. Results: These patients tend to be younger and nonmultiparous as compared t o other patients with thoracic endometriosis. Bronchoscopic examination per formed within 1 day or 2 days of menses disclosed multiple purplish-red sub mucosal patches bilaterally that bled easily when touched. Cytologic evalua tion of the brushing specimens demonstrated clusters of small cuboid cells consistent with an endometrial origin. Follow-up bronchoscopic examination in the middle of the menstrual cycle showed disappearance of the previous t racheobronchial lesions. The mean diagnostic interval was 3.25 months, All four patients were successfully treated with danazol therapy, Conclusions: Tracheobronchial endometriosis consists of a special subgroup of patients with thoracic endometriosis. Proper timing of bronchoscopic exa mination plays an important diagnostic role in these patients. Cytologic fe atures as well as cyclic changes in bronchoscopic findings are sufficient t o warrant the diagnosis. The results of treatment with danazol in these pat ients seemed favorable.