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The cysts can release blood; the endometrial cyst "menstruates" in the lung. Endometrial cells undergo structural changes during the secretory phase of the menstrual cycle, in a process called decidualization. Decidualized pleural endometrial implants can disrupt the pleura and lead to pneumothorax (and hemothorax). [11]
A further use of CT is in the identification of underlying lung lesions. In presumed primary pneumothorax, it may help to identify blebs or cystic lesions (in anticipation of treatment, see below), and in secondary pneumothorax, it can help to identify most of the causes listed above. [15] [19]
On radiological studies, pneumothorax is visualized using conventional chest x-rays and CT scans. In 90% of the cases, the pneumothorax is located on the right side. In some cases, small nodules can be seen in the pleura using CT scans. Confirmation can be done using video assisted thoracoscopic surgery (VATS). [8]
The terms cavity and cyst are frequently used interchangeably; however, a cavity is thick walled (at least 5 mm), while a cyst is thin walled (4 mm or less). The distinction is important because cystic lesions are unlikely to be cancer, while cavitary lesions are often caused by cancer. [3]
Chest x-ray of infant showing CPAM in the left lung causing a mediastinal shift towards the right. The cysts appear as bubbles in the left lung. Congenital pulmonary airway malformation (CPAM) is a rare disease in which the lung airways develop abnormally in the fetus. This leads to infants having pockets of air and cystic masses in their lungs.
Hereditary recurrent pneumothorax or pulmonary cysts are associated with Marfan syndrome, Ehlers–Danlos syndrome, tuberous sclerosis complex, alpha1-antitrypsin deficiency, and cystic fibrosis. Nonhereditary recurrent pneumothorax and/or pulmonary cysts can occur with Langerhans cell histiocytosis and lymphangioleiomyomatosis.
Within these ascus-like cysts, eight spores form, which are released through rupture of the cyst wall. The cysts often collapse, forming crescent-shaped bodies visible in stained tissue. Whether meiosis takes place within the cysts, or what the genetic status is of the various cell types, is not known for certain. [2]
Therefore, pneumothorax is usually more of a problem than hemothorax. [8] A pneumothorax may form or be turned into a tension pneumothorax by mechanical ventilation, which may force air out of the tear in the lung. [12] The laceration may also close up by itself, which can cause it to trap blood and potentially form a cyst or hematoma. [8]