Correspondence

Endometriosis in the Thoracic Aorta

N Engl J Med 1998; 339:1002-1003October 1, 1998

Article

To the Editor:

Manifestations of endometriosis in thoracic organs are very rare.1,2 We describe a case of endometriosis in the thoracic aorta.

After an uneventful pregnancy, a 28-year-old woman delivered a healthy girl by elective cesarean section. The procedure was complicated by severe, intractable hypertension. No cause was found for the severe hypertension, which was still present several weeks after delivery. A chest x-ray film and computed tomographic scan obtained postoperatively showed a pseudoaneurysm of the descending aorta with a maximal diameter of 9 cm in the area of a patch repair of a coarctation, which had been performed 16 years earlier. During her first pregnancy at the age of 24, which had also resulted in cesarean section, the patient had hypertension but no signs of gestosis. Arterial hypertension resolved without treatment after delivery. A chest x-ray film was normal at that time.

We operated on the patient three weeks after the second cesarean section. Intraoperatively, we found a rupture of the suture line of the distal part of the patch, with a false aneurysm bulging into the left lung. The patch and the aneurysm were excised, and a 28-mm Dacron–velour prosthesis was inserted. The postoperative course was complicated only by hypertension, which began to respond to medical treatment after one week. The patient was doing well at follow-up two months later. Microscopically, there was atherosclerosis of the intima, medial fibrosis with foci of calcification, and periaortic fibrosis. At the resection line of the aneurysm, endometrial glands were detected. Between the endometrial glands, which were lined with ciliated or nonciliated epithelium that ranged from cuboidal to highly prismatic, and the stroma were signs of old and recent hemorrhages embedded in a fibrous mass. The cysts were lined with several layers of hemosiderin-laden macrophages. In some cystic, dilated glands, the repeated hemorrhages had totally destroyed the endometrial tissue. In addition, a mild-to-moderate lymphoplasmatic infiltrate was visible in the adjacent tissue (Figure 1Figure 1Histologic Cross Section of the Aortic Wall at the Area of Dissection, Showing Endometriosis between the Media and the Adventitial Connective Tissue (Arrow) (Hematoxylin and Eosin, ×25).). Immunohistochemically, hormone receptors, especially for progesterone and to a lesser extent for estrogen, were detected in the lining cells.

It remains speculative whether the endometriosis of the aortic wall allowed the development of the false aneurysm and the rupture of the suture line by weakening the aortic wall.

Axel Nötzold, M.D.
Pierre Moubayed, M.D.
Hans-Hinrich Sievers, M.D., Ph.D.
Medical University of Lübeck, 23538 Lübeck, Germany

2 References

1. 1

   Wood DJ, Krishnan K, Stocks P, Morgan E, Ward MJ. Catamenial haemoptysis: a rare cause. Thorax 1993;48:1048-1049
   CrossRef | Web of Science | Medline

2. 2

   Joseph J, Reed CE, Sahn SA. Thoracic endometriosis: recurrence following hysterectomy with bilateral salpingo-oophorectomy and successful treatment with talc pleurodesis. Chest 1994;106:1894-1896
   CrossRef | Web of Science | Medline

Citing Articles (3)

Citing Articles

1. 1

   R. Flyckt, S. Lyden, A. Roma, T. Falcone. (2011) Post-menopausal endometriosis with inferior vena cava invasion requiring surgical management. Human Reproduction 26:10, 2709-2712
   CrossRef

2. 2

   Antonio Bobbio, Diane Damotte, Anne Gompel, Marco Alifano. 2011. Extra-Abdominal Endometriosis. , 108-114.
   CrossRef

3. 3

   Margaret M Johnson. (2004) Catamenial pneumothorax and other thoracic manifestations of endometriosis. Clinics in Chest Medicine 25:2, 311-319
   CrossRef