Gynecologic Evaluation of Catamenial Pneumothorax Associated with Endometriosis

Jun Kumakiri, Kumakiri J, Yuko Kumakiri, Kumakiri Y, Miyamoto H, Hideaki Miyamoto, Iwaho Kikuchi, Arakawa A, Atsushi Arakawa, Mari Kitade, Kitade M, Satoru Takeda
Journal of Minimally Invasive Gynecology · 2010 · vol. 17(5) , pp. 593–599 · doi:10.1016/j.jmig.2010.04.011 · PMID:20580323 · W2075369748
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This paper describes the gynecologic evaluation of catamenial pneumothorax, a rare condition where chest air leakage occurs cyclically with menstruation, often linked to endometriosis.

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Abstract

Study objectiveTo assess the pathogenesis of catamenial pneumothorax associated with endometriosis from a gynecologic perspective.DesignRetrospective study (Canadian Task Force classification II-2).SettingUniversity hospital.PatientsEleven patients with clinically suspected catamenial pneumothorax due to frequently recurrent pneumothorax who underwent thoracoscopy between September 2003 and February 2007 at our hospital.InterventionVideo-assisted thoracoscopy.Measurements and main resultsEpisodes of pneumothorax, coexistence of intrapelvic endometriosis, classification of intrathoracic lesions according to the appearance of pelvic endometriosis using the revised American Society of Reproductive Medicine (re-ASRM) classification, and histopathologic findings in intrathoracic specimens were assessed. A total of 38 episodes of pneumothorax, all on the right side, were documented in 11 patients with catamenial pneumothorax. Median (range) patient age at the initial pneumothorax was 42 (29-47) years. The re-ASRM score in 6 patients in whom pelvic endometriosis was directly observed at laparoscopy and laparotomy was 56 (18-96). We postoperatively reviewed videotape recordings of video-assisted thoracoscopy, and observed superficial thoracic diaphragmatic lesions classified as red (n = 5), black (n = 8), and white (n = 9) with fenestration according to the re-ASRM classifications for pelvic endometriosis. Tissue associated with endometriosis was detected at histopathologic analysis of resected diaphragmatic lesions in 9 patients. No endometriosis was identified at histopathologic analysis of visceral pleural lesions in 7 patients who underwent lung resection.ConclusionsGynecologic evaluation of catamenial pneumothorax associated with endometriosis is crucial to clarify the unelucidated pathogenesis of the disease.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Menstruation Pneumothorax Pneumothorax Thoracic Surgery, Video-Assisted Adult Endometriosis Endometriosis Female Humans Middle Aged Pneumothorax Pneumothorax Retrospective Studies

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