{"paper_id":"dc7e4945-d969-4b18-bc13-f900b048da02","body_text":"Catamenial Pneumothorax\nKiyoshi Shikino, MD, PhD, Yoshiyuki Ohira, MD, PhD, and Masatomi Ikusaka, MD, PhD\nDepartment of General Medicine, Chiba University Hospital, Chiba-city, Chiba pref., Japan.\nKEY WORDS: blueberry spots; catamenial; pneumothorax.\nJG e nI n t e r nM e d3 1 ( 1 0 ) : 1 2 6 0\nDOI: 10.1007/s11606-016-3674-6\n© Society of General Internal Medicine 2016\nA\n46-year-old woman presented with 3 days of dyspnea\nand right-sided pleuritic chest pain. She mentioned sev-\nen prior episodes of mild shortness of breath and right-sided\npleuritic chest pain occurring within 48 hours of menstruation\nonset. Physical examination revealed tachypnea and decreased\nlung sounds on the right, with hyper-resonance on percussion.\nChest radiograph showed a collapsed right lung (Fig. 1). Lab-\noratory tests revealed high levels of cancer antigen-125, sug-\ngesting endometriosis. Thoracoscopy showed multiple dia-\nphragmatic blueberry spots at the periphery of the central\ntendon’s right leaflet (Fig. 2). The patient was diagnosed with\ncatamenial pneumothorax. She underwent video-assisted\nthoracoscopic surgery and hormonal therapy with danazol.\nAfter 5 years, there has been no clinical evidence of\nrecurrence.\nCatamenial pneumothorax, which affects women of repro-\nductive age and occurs within 72 h of menstruation onset,\n1 is\nthe most common manifestation of thoracic endometriosis. The\nright side is involved in the majority of cases.\n2 Endometrial\nimplants are visualized as blueberry spots on the\npleurodiaphragmatic surface. A combination of video-assisted\nthoracoscopic surgery and hormonal therapy (gonadotropin-\nreleasing hormone analogs, danazol or aromatase inhibitors\nfor 6 to 12 months) is the preferred approach for treatment\nand prevention.\n3,4\nCorresponding Author: Kiyoshi Shikino, MD, PhD; Department of\nGeneral MedicineChiba University Hospital, 1-8-1, Inohana, Chuo-ku,\nChiba-city, Chiba pref., Japan (e-mail: kshikino@gmail.com).\nCompliance with Ethical Standards:\nConflict of Interest: The authors declare that they do not have a\nconflict of interest.\nREFERENCES\n1. Peikert T, Gillespie DJ, Cassivi SD. Catamenial pneumothorax. Mayo Clin\nProc. 2005;80(5):677–80.\n2. Alifano M, Roth T, Broët SC, Schussler O, Magdeleinat P , Regnard JF .\nCatamenial pneumothorax: a prospective study. Chest. 2003;124(3):1004–8.\n3. Attaran S, Bille A, Karenovics W , Lang-Lazdunski L. Videothoracoscopic\nrepair of diaphragm and pleurectomy/abrasion in patients with catamenial\npneumothorax: a 9-year experience. Chest. 2013;143(4):1066–9.\n4. Azizad-Pinto P , Clarke D. Thoracic endometriosis syndrome: case report\nand review of the literature. Perm J. 2014;18(3):61 –5.\nFig. 1 Chest radiograph shows a collapsed right lung.\nReceived January 25, 2016\nRevised February 12, 2016\nAccepted March 11, 2016\nPublished online March 24, 2016\nFig. 2 Thoracoscopy shows multiple diaphragmatic blueberry spots\nat the periphery of the central tendon ’s right leaflet ( arrows).\n1260","source_license":"CC0","license_restricted":false}