Pneumothorax at menses caused by concomitant diaphragmatic endometriosis and a leaking bulla: a case report

Menses-associated pneumothorax has largely been attributed to thoracic endometriosis. We report a case of a 37-year-old woman who presented with a right pneumothorax during menses and was found, on thoracoscopy, to have diaphragmatic endometriosis causing fenestrations in the tendinous diaphragm and a pulmonary bulla. A water-seal test demonstrated an air leak from the bulla. The patient then underwent a video-assisted thoracoscopic resection of the bulla and the involved portion of the diaphragm. Pathologic examination of diaphragmatic lesions demonstrated endometrial glands. The patient was treated with chemical pleurodesis and hormonal suppression of her endometriosis. She is currently symptom-free at 12 months of follow-up.

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