Operative and hormonal management of recurrent catamenial pneumothorax: a case report

Sivaraman Iyer, Jessica Clay Ehrig, Marcos Sosa, J.L. Phy
In: The Southwest Respiratory and Critical Care Chronicles · 2018 · vol. 6(26) , pp. 22–25 · doi:10.12746/swrccc.v6i26.494 · W2896245081
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This case report describes a successful treatment for recurrent catamenial pneumothorax with hysterectomy and bilateral salpingo-oophorectomy, after which the patient experienced no further episodes.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This case report describes a 37-year-old woman with abdominal endometriosis who experienced five recurrent right pneumothoraces that occurred in synchrony with her menstrual cycle; catamenial pneumothorax and thoracic endometriosis syndrome were diagnosed. The patient underwent operative management with hysterectomy and bilateral salpingo-oophorectomy, and combined transdermal estrogen/progesterone was started to address post-surgical symptoms; after treatment, no pneumothorax recurrence was reported. The authors note major uncertainty because the rarity of catamenial pneumothorax leaves recommendations—especially the duration of combined estrogen/progesterone after bilateral oophorectomy—underdeveloped, and they emphasize the need for multidisciplinary care due to diagnostic and treatment challenges. This paper is centrally about endometriosis — it presents thoracic endometriosis syndrome manifested as catamenial pneumothorax and reports outcomes after hysterectomy, bilateral salpingo-oophorectomy, and hormonal therapy.

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Abstract

Catamenial pneumothorax refers to the recurrent collapse of a lung in conjunction with the menstrual cycle. It is a common manifestation of thoracic endometriosis syndrome, a rare condition involving extra-pelvic endometrial lesions. We describe a case of catamenial pneumothorax that has not recurred after treatment with hysterectomy and bilateral salpingo-oophorectomy. A 37-year-old woman with abdominal endometriosis presented with five episodes of right pneumothorax, all of which coincided with the patient’s menstrual cycle. The diagnosis of catamenial pneumothorax was made, and the patient was referred for hysterectomy and bilateral salpingo-oophorectomy. Combined transdermal estrogen/progesterone treatment was also initiated to manage her symptoms of hot flashes, vaginal dryness, and dyspareunia. Since treatment, the patient has not had recurrent pneumothorax. Due to the rarity and acuity of catamenial pneumothoraces, management options are challenging. Recommendations on the duration of combined estrogen/progesterone treatment following bilateral oophorectomy are needed. A multidisciplinary team approach consisting of pulmonologists, thoracic surgeons, and gynecologists is essential for accurate diagnosis, optimal treatment, and successful outcomes in this rare but serious condition.
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Abstract

Catamenial pneumothorax refers to the recurrent collapse of a lung in conjunction with the menstrual cycle. It is a common manifestation of thoracic endometriosis syndrome, a rare condition involving extra-pelvic endometrial lesions. We describe a case of catamenial pneumothorax that has not recurred after treatment with hysterectomy and bilateral salpingo-oophorectomy. A 37-year-old woman with abdominal endometriosis presented with five episodes of right pneumothorax, all of which coincided with the patient’s menstrual cycle. The diagnosis of catamenial pneumothorax was made, and the patient was referred for hysterectomy and bilateral salpingo-oophorectomy. Combined transdermal estrogen/progesterone treatment was also initiated to manage her symptoms of hot flashes, vaginal dryness, and dyspareunia. Since treatment, the patient has not had recurrent pneumothorax. Due to the rarity and acuity of catamenial pneumothoraces, management options are challenging. Recommendations on the duration of combined estrogen/progesterone treatment following bilateral oophorectomy are needed. A multidisciplinary team approach consisting of pulmonologists, thoracic surgeons, and gynecologists is essential for accurate diagnosis, optimal treatment, and successful outcomes in this rare but serious condition.Downloads

References

Olive DL, Schwartz LB. Endometriosis. N Engl J Med 1993;328(24):1759-1769. Lee HJ, Park YM, Jee BC, et al. Various anatomic locations of surgically proven endometriosis: A single-center experience. Obstetrics & Gynecology Science 2015;58(1):53-58. Bagan P, Berna P, Assouad J, et al. Value of cancer antigen 125 for diagnosis of pleural endometriosis in females with recurrent pneumothorax. European Respiratory J 2008;31(1):140-142. Rousset P, Rousset-Jablonski C, Alifano M, et al. Thoracic endometriosis syndrome: CT and MRI features. Clinical Radiology 2014;69(3):323-330. Azizad-Pinto P, Clarke D. Thoracic endometriosis syndrome: case report and review of the literature. The Permanente Journal 2014;18(3):61-65. Visouli AN, Zarogoulidis K, Kougioumtzi I, et al. Catamenial pneumothorax. J Thoracic Disease 2014;6(Suppl 4): S448-S460. Alifano M, Jablonski C, Kadiri H, et al. Catamenial and noncatamenial, endometriosis-related or nonendometriosis-related pneumothorax referred for surgery. American J Respiratory Critical Care Medicine 2007;176(10):1048-1053. Joseph J, Sahn SA. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. The American J Medicine1996;100(2):164-170. Channabasavaiah AD, Joseph JV. Thoracic endometriosis: revisiting the association between clinical presentation and thoracic pathology based on thoracoscopic findings in 110 patients. Medicine 2010;89(3). Legras A, Mansuet-Lupo A, Rousset-Jablonski C, et al. pneumothorax in women of child-bearing age: an update classification based on clinical and pathologic findings. Chest 2014;145(2):354-360. Korom S, Canyurt H, Missbach A, et al. Catamenial pneumothorax revisited: Clinical approach and systematic review of the literature. The J Thoracic and Cardiovascular Surgery 2004;128(4):502-508. Attaran S, Bille A, Karenovics W, et al. Videothoracoscopic repair of diaphragm and pleurectomy/abrasion in patients with catamenial pneumothorax: a 9-year experience. Chest 2013;143(4):1066-1069.

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