Breathless Cycles: A Case Report on Rare Catamenial Pneumothorax

Abstract Introduction Thoracic endometriosis is a rare form of endometriosis where endometrial-like tissue grows on the diaphragm, pleura, or lungs, primarily affecting women of reproductive age. Symptoms include catamenial pneumothorax (lung collapse linked to menstruation), hemothorax, and hemoptysis. Incidence in spontaneous pneumothorax cases is 3-6%, rising to 25-33% in women needing surgical intervention. [1-4] Diagnosis often involves imaging, potentially showing pulmonary nodules, and may require pleural or diaphragmatic biopsy. Initial treatment usually includes hormonal therapy; if unsuccessful, video-assisted thoracoscopic surgery (VATS) may be needed. Hormonal suppression, including oral contraceptives, helps reduce recurrence and future complications. Case Report A 36-year-old female with a history of uterine fibroids, endometriosis, and chronic right shoulder pain presented to the ED with constant acute onset right-sided chest pain, initially believed to be her chronic right shoulder pain, but with new shortness of breath. The pain was non-exertional, pleuritic, and occurred five days post-menstruation. She denied any predisposing risk factors. Imaging revealed a right-sided apical spontaneous pneumothorax. Despite being hemodynamically stable, conservative management failed to resolve the pneumothorax, necessitating prolonged chest tube placement before improvement. She was started on hormone suppression therapy, and outpatient repeat imaging confirmed complete resolution. Novelty/Importance This case highlights the potential for thoracic endometriosis in patients with endometriosis presenting with minimal symptoms and the importance of early recognition, as undetected thoracic endometriosis can lead to severe complications such as cardiac tamponade, respiratory failure, recurrent pneumothorax, infection, and pleural bleeding. References:1.Catamenial Pneumothorax: A Rare Entity? Report of 5 Cases and Review of the Literature. Visouli AN, Darwiche K, Mpakas A, et al.Journal of Thoracic Disease. 2012;4 Suppl 1:17-31. doi:10.3978/j.issn.2072-1439.2012.s006.Details2. Menstruation-Related Spontaneous Pneumothorax and Diaphragmatic Endometriosis. Härkki P, Jokinen JJ, Salo JA, Sihvo E.Acta Obstetricia Et Gynecologica Scandinavica. 2010;89(9):1192-6. doi:10.3109/00016349.2010.493194.Details3.Catamenial andNoncatamenial, Endometriosis-Related orNonendometriosis-Related Pneumothorax Referred for Surgery. Alifano M, Jablonski C, Kadiri H, et al.American Journal of Respiratory and Critical Care Medicine. 2007;176(10):1048-53. doi:10.1164/rccm.200704-587OC.Details4.Catamenial Pneumothorax. Alifano M.Current Opinion in Pulmonary Medicine. 2010;16(4):381-6. doi:10.1097/MCP.0b013e32833a9fc2.