Catamenial Pneumothorax: An Example of a Porous Diaphragm-Case Report

Yiheng Liu, Chih‐Yen Tu, Chia‐Hung Chen, Hung‐Jen Chen, Chuen‐Ming Shih, Chih-Yi Chen
In: 胸腔醫學 · 2006 · vol. 21(6) , pp. 551–555 · doi:10.29806/tm.200612.0011 · W1551008275
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This case report describes a 36-year-old woman with recurrent right-sided catamenial pneumothorax, defined as spontaneous air accumulation in the chest occurring within 72 hours of menstruation onset. Surgical exploration revealed multiple small defects in the diaphragm and brown pigment spots on the parietal pleura, yet histological analysis confirmed the absence of endometrial tissue or thoracic endometriosis. Closure of these diaphragmatic holes via suturing successfully prevented further recurrence of the pneumothorax in this patient. Relevance to endometriosis: the paper explicitly notes that while the condition is linked to menstrual cycles, no endometriosis was found, suggesting an alternative porous diaphragm mechanism rather than classic adenomyosis or endometriosis involvement.

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Abstract

Catamenial pneumothorax is currently considered to be a very unusual clinical condition. It has been defined as a spontaneous and recurrent pneumothorax occurring within 72h from the onset of menstruation. The first attack usually occurs in women during the 3rd or 4th decade of life, and is mostly involved in the right lung. However, the exact incidence, pathogenic mechanisms, and optimal management of catamenial pneumothorax remain unclear. We report a 36-year-old female patient with right catamenial pneumothorax that recurred 5 times, and who was found, at surgery, to have many diaphragmatic holes without signs of diaphragmatic or thoracic endometriosis. After the diaphragmatic holes had been closed with sutures, the patient no longer suffered recurrent right-side pneumothorax. Thus, a consideration of catamenial pneumothorax in women of reproductive age with recurrent spontaneous pneumothorax is warranted. Evaluation of the diaphragm is necessary, and if holes are seen, they should be sutured closed to prevent recurrence.
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- 期刊 月經性(catamenial)氣胸臨床上是一個很少見的疾病。它通常發在三十到四十歲的女性病人，並且在月經第一天的前後七十二小時內發生。另外，大部分發生在右邊(95%)。它的致病機轉雖然不明，但有很多論點在討論之中。因此我們報告了這則病例。 本篇文章我們介紹一個病例為36歲女性每次月經來時常合併右側氣胸，經由pig-tail引流、甚至開刀和肋膜沾黏術後右側氣胸仍然反覆發作。在第二次開刀時發現右側橫膈有很多個約0.5至0.8公分破洞，並且壁側肋膜有數個棕色色素斑點。病理切片為慢性發炎，並無發現子宮內膜異位。經縫合橫膈破洞之治療後，至今未再復發。同時希望藉由本篇文章之討論能引起更多臨床醫師注意，因為我們在女性病患併有氣胸作病史時常常忽略月經與氣胸之問的關係。橫膈膜破洞可能在月經性氣胸扮演重要的角色。 Catamenial pneumothorax is currently considered to be a very unusual clinical condition. It has been defined as a spontaneous and recurrent pneumothorax occurring within 72h from the onset of menstruation. The first attack usually occurs in women during the 3rd or 4th decade of life, and is mostly involved in the right lung. However, the exact incidence, pathogenic mechanisms, and optimal management of catamenial pneumothorax remain unclear. We report a 36-year-old female patient with right catamenial pneumothorax that recurred 5 times, and who was found, at surgery, to have many diaphragmatic holes without signs of diaphragmatic or thoracic endometriosis. After the diaphragmatic holes had been closed with sutures, the patient no longer suffered recurrent right-side pneumothorax. Thus, a consideration of catamenial pneumothorax in women of reproductive age with recurrent spontaneous pneumothorax is warranted. Evaluation of the diaphragm is necessary, and if holes are seen, they should be sutured closed to prevent recurrence.

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