Multi-Loculated Catamenial Pneumothorax: A Rare Complication of Thoracic Endometriosis

Grace Staring, Fátima Monteiro, Ivone Barracha, Rosa Amorim
Cureus · 2021 · vol. 13(8) , pp. e17583 · doi:10.7759/cureus.17583 · PMID:34646637 · PMC8481132 · W3198834200
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This case report details a 37-year-old woman with recurrent right catamenial pneumothorax, diagnosed by imaging, treated with drainage, hormonal therapy, VATS, and ultimately hysterectomy for diaphragmatic endometriosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper reports a case of a 37-year-old non-smoker with recurrent right catamenial pneumothorax (48 hours after menses), initially managed with chest drainage and continuous combined oral contraceptive therapy, followed by recurrence as a multiloculated pneumothorax. She then underwent video-assisted thoracoscopic surgery (VATS), where multiple diaphragmatic fenestrations and a nodular diaphragmatic pleural thickening were observed and histology confirmed endometrial tissue; pleurodesis and subsequent hormonal therapy (switching to goserelin and dienogest) were followed by further recurrence. A total hysterectomy ultimately resulted in stable precocious menopause, and the uterine/appendage pathology reportedly showed no evidence of endometriosis, with the authors describing the case as the first non-gynecological deep infiltrating endometriosis presentation. This paper is centrally about endometriosis — it documents thoracic endometriosis presenting as multi-loculated catamenial pneumothorax with surgically confirmed diaphragmatic and pleural endometrial deposits.

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Abstract

The presence of endometrial tissue outside the uterine cavity is known as endometriosis. Catamenial pneumothorax (CP) is a recurrent spontaneous pneumothorax that occurs in women of childbearing age. Thoracic endometriosis is a rare clinical entity, and CP is the most common presentation. Imaging diagnosis is based on computed tomography (CT) scans and magnetic resonance imaging (MRI), detecting blood products in endometrial deposits. We report a case of right CP in a 37-year-old woman with chest pain and dyspnea 48 hours after the onset of menstruation. The pneumothorax was drained, continuous hormonal therapy was started, and she underwent video-assisted thoracoscopic surgery (VATS), which revealed multiple diaphragmatic fenestrations and a solitary nodular thickening in the diaphragmatic pleura (endometrial deposit). After pleurodesis, multiple CP recurred, and later underwent a total hysterectomy. CP is the most common form of thoracic endometriosis and should be suspected in women of childbearing age.

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endometriosisthoracic_endometriosis

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