Catamenial pneumothorax revisited: Clinical approach and systematic review of the literature

Stephan Korom, Korom S, Canyurt H, Haydar Canyurt, Antje Missbach, Didier Schneiter, Schneiter D, Kurrer MO, Michael Kurrer, Michael Odo Kurrer, Haller U, Urs Haller, U. Haller, Paul J. Keller, Keller PJ, Markus Furrer, Furrer M, Walter Weder, Weder W
The Journal of thoracic and cardiovascular surgery · 2004 · vol. 128(4) , pp. 502–508 · doi:10.1016/j.jtcvs.2004.04.039 · PMID:15457149 · W2041118863
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This paper reviews the clinical approach to catamenial pneumothorax and systematically analyzes existing literature to identify treatment strategies and outcomes.

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Abstract

BackgroundCatamenial pneumothorax is a rare entity of spontaneous, recurring pneumothorax in women. It has been associated with thoracic endometriosis, yet varying clinical courses and the lack of consistent intraoperative findings have led to conflicting etiologic theories.MethodsWe discuss etiology, clinical course, and surgical treatment of 3 women with catamenial pneumothorax. In addition, the world literature since the first description is reviewed.ResultsThree women (31, 32, and 39 years old) had recurrent, menses-associated, right-sided spontaneous pneumothoraces. They had undergone video-assisted thoracoscopic surgery previously, with various unsuccessful procedures. Finally, with video-assisted thoracoscopic surgery multiple small perforations in the tendinous part of the right diaphragm with adjacent endometrial implants were detected. After plication of the involved area, 2 patients have been free of recurrence for 22 and 13 months, respectively. Laparoscopic evaluation in 1 woman with a further recurrence revealed asymptomatic pelvic endometriosis. This patient has been free of recurrence since initiation of luteinizing hormone-releasing hormone analog therapy for 17 months. In a review of 229 cases of catamenial pneumothorax in the literature, adequate information was given for 195 patients (85.2%). One hundred fifty-four (79%) were treated surgically, with detailed findings reported for 140 (91%). Thoracic endometriosis was diagnosed in 73 patients (52.1%), and 54 (38.8%) showed diaphragmatic lesions. Pleurodesis, with or without diaphragmatic repair or wedge resection, was performed in 81.7% of the cases.ConclusionsCatamenial pneumothorax may be suspected in ovulating women with spontaneous pneumothorax, even in the absence of symptoms associated with pelvic endometriosis. During video-assisted thoracoscopic surgery, inspection of the diaphragmatic surface is paramount. Plication of the involved area alone can be successful. In complicated cases, hormonal suppression therapy is a helpful adjunct.

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Condition tags

endometriosis

MeSH descriptors

Menstruation Pneumothorax Adult Endometriosis Endometriosis Endometriosis Female Humans Pleurodesis Pleurodesis Pneumothorax Pneumothorax Pneumothorax Pneumothorax Thoracic Surgery, Video-Assisted

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