Endometriosis in Lung

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Lisa Sanders, Labored Breathing. The woman was fit and healthy, but then one of her lungs began to mysteriously collapsing. Why? New York Times Magazine, Apr 1, 2018.
https://www.nytimes.com/2018/03/ ... ously-collapse.html

Note:
(a) "It was 2 am * * * She [a 45-year-old wife] had an oxygen meter [pulse oximeter] on her finger * * * 'I can't breathe' she told him [husband]. She'd had chest pain and felt short of breath in the past, but her oxygen had never been this low — down to 89 or 90 percent [normal: >95]. And the right side of her chest felt as if it were on fire. * * * her right lung collapsed and all the trouble began two years earlier. That first time had been nothing like this. Back then, there was a strange click [in retrospect: a hole in * * * ], then a feeling that something had moved [lung collapsed]. It wasn’t painful, just odd. * * * [at the time[ Her doctor ordered a chest X-ray and saw to his surprise that her right lung had collapsed [x -ray would have shown pneumothorax: air, hence blackness, where the right lung should be]."

(b) In the second episode: "At Lenox Hill Hospital * * * Dr Byron Patton, a thoracic surgeon, recommended a procedure known as pleurodesis, in which the lung is mechanically attached to the surrounding sack called the pleura, so that even if the lung developed another leak, it wouldn't collapse. It [the same episode: click, a twinge or stab; but no pneumothorax thanks to pleurodesis] It happened almost 20 times."
(i) Lenox Hill Hospital
https://en.wikipedia.org/wiki/Lenox_Hill_Hospital
(1857- ; name changed in 1918 from a hospital with German in its name [Germany was unpopular in US back then] to Lenox Hill Hospital, tying it to the Lenox Hill section of the Upper East Side; private, non-profit; a teaching hospital for Hofstra Northwell School of Medicine)
(ii) Click Lenox Hill and Wikipedia has this to say: a hill at Upper East Side that was "named after immigrant Scottish merchant Robert Lenox (1759-1839), who owned about 30 acres" there.
(iii) pleurodesis (n; from pleuro- [combining form for pleura] + ancient Greek δέσις [Romanization: desis] binding together; Earlier Known Use 1940s)
https://en.oxforddictionaries.com/definition/pleurodesis
(pronunciation)
(iv)
(A) pleura 胸膜 (n; Medieval Latin, from Greek, rib, side; plural: pleurae (when treated as Latin) or pleuras (when treated as English)
https://www.merriam-webster.com/dictionary/pleura

Its adjective (pleural) has the same pronunciation with plural (adj) 复数的.
(B) pleural cavity  胸膜腔
https://en.wikipedia.org/wiki/Pleural_cavity
(is the thin fluid-filled space between the two pulmonary pleurae (known as visceral 内脏的 [on the surface of a lung] and parietal 壁的 [lining the inner wall of chest cavity]) of each lung)

(c) "there was a link, albeit rare, between pneumothorax and endometriosis — a disorder in which tiny dots of the inner lining of the uterus tissue, known as endometrium, move into other parts of the body. Women who have endometriosis can have episodes of pneumothorax if those cells make their way past the diaphragm into the chest. * * * In the chest cavity, it could cause what was called a catamenial (derived from the Greek for monthly) pneumothorax. But did her episodes of pneumothorax come with her period? She wasn't sure."

catamenia (n; Greek, neuter plural form of katamēnios monthly, from kata down + mēn month; First Known Use  mid 18th century)
https://en.oxforddictionaries.com/definition/catamenia

The word catamenial is the adjective form of catamenia.
(d) "Patton had suggested starting birth-control pills to suppress the hormonal changes. She began taking them three weeks before the horrible night at her weekend home, which left her with difficulty breathing."

There are various birth-control pills to treat endometriosis: progestin alone, or combined (estrogen and progestin). (Progestin is synthetic variant of (natural) progesterone.)  Suffice it to say estrogen promotes growth of endometrium (in and out of uterus). The treatment goal is to stop it, for eventually the overgrown endometrium has to shed, accompanied by bleeding. This is the source of inflammation and pain.

(e) "Mother and patient urged the two subspecialists [Dr Tamer Seckin, a gynecologic surgeon;  to work together in the operating room, and they agreed.  The operation * * * took five hours. Seckin went first. He looked in the abdomen and pelvis and found many endometrial implants. He saw small patches of wayward cells on the bladder and the intestines and scattered across the abdominal and pelvic walls. But he did not see any on the bottom side of the diaphragm 横膈膜 * * * Then it was Patton's turn. He would examine the chest and lungs. The patient was placed on her left side [meaning left side at the bottom, and right side at the top; because her problem was with right lung/chest; this necessarily means that left chest cavity was not explored], and the camera and surgical instruments were inserted between her ribs into the right side of her chest [this sounds like thoracoscope, not an incision to examine with naked eyes of a surgeon]. Patton carefully examined the smooth, curved upper surface of the diaphragm. Directly below the lung there was a patch of purple tissue, a little smaller than a dime. Were those the endometrial cells? Patton cut out the abnormal-looking tissue then sewed up the hole. He scanned the lung, from top to bottom, and found another small patch of abnormal-appearing tissue, which he cut out as well. The samples were sent to the pathology lab. He then fastened her lung to the pleural surface of her chest again [pleurodesis]. Before the operation was finished, the [pathological] results were back from the lab. The tissue on the diaphragm was endometriosis. She had catamenial pneumothorax disease."

The essay does not say how many incisions: one for abdomen and a second for thorax? Or just one gigantic one for both cavities? This is called exploratory operation .surgery. But why not two scopes (laparoscope 腹镜 and thoracoscope 胸镜).
(f)
(i) Endometriosis is odd: for example, three cases have been reported that found endometrium in brain, with resulting blood inside a cyst (body forms the cyst to isolate the irritating blood). For lack of an animal model (no experimenting with humans), cause, prevalence and how it develops (since adolescence? since childhood? Since fetus?) of endometriosis is unknown.   
(ii) Azizad-Pinto P, Thoracic Endometriosis Syndrome: Case Report and Review of the Literature. Permanente Journal, 18: 61–65 (2014)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116267/
("Three theories [without experimental support] have developed to explain this entity [catamenial pneumothorax]. The first is transdiaphragmatic passage, or movement, of air from the vagina to the peritoneum via the fallopian tubes, and subsequently to the thorax via diaphragmatic fenestrations. This is thought to occur during the menstrual cycle when the cervical mucus plug is absent. The second is air leakage triggered by sloughing of the endometrial implants located on the pleura. The third proposes a hormonally mediated mechanism in which high levels of prostaglandin from thoracic endometrial implants cause vascular and bronchiolar vasoconstriction, leading to ischemic injury and ultimately causing alveolar rupture and subsequent air leakage")  (citations omitted)

Three theories in plain English:
* air via vagina, uterus, 输卵管, abdominal cavity, a hole (definitely abnormal) in diagram to pleural cavity;
* endometrium on visceral pleura caused a hole when it sheds (during menstruation);
* 前列腺素 from endometrium brings about 血管收缩, resulting in (lung) tissue necrosis and a hole.