妊娠中に発症した胸腔子宮内膜症性気胸の1例

Thoracic Endometriosis Pneumothorax During Pregnancy：Report of a Case

はじめに　胸腔子宮内膜症性気胸1）は妊娠中や排卵抑制薬使用中，子宮・卵巣切除後は通常起こらないとされる2）．われわれは妊娠中に発症し，手術でブラ切除・縫縮および生検を行い，治療と病理診断を行った胸腔子宮内膜症性気胸の1例を経験したので報告する．

A 41-year-old woman was 17 weeks pregnant. While visiting the obstetrics and gynecology department of our hospital, she visited the emergency room with complaints of right shoulder pain, chest pain, and dyspnea, and chest X-ray showed right-sided pneumothorax. The air leak did not improve even after chest tube drainage；therefore, the patient underwent thoracoscopic surgery. We resected and sutured a bulla on the middle lobe, which was the cause of the pneumothorax and was covered with a 0.15-mm-thick polyglycolic acid sheet. The chest wall lesion was resected to the maximum extent possible. In addition, the diaphragmatic lesion was biopsied with a 0.5-mm-thick polyglycolic acid sheet and an oxidized regenerated cellulose sheet. Twenty milliliters of 50％ glucose solution were applied around each covered lesion. A pathologic examination revealed CD10 and estrogen receptor-positive endometrial stromal cells in all lesions, which were diagnosed as thoracic endometriosis. The patient was scheduled to begin hormone therapy for thoracic endometriosis to prevent pneumothorax after delivery. We should consider thoracic endometriosis as a differential diagnosis, even in pregnant patients.