Catamenial pneumothorax: optimal hormonal and surgical management

M Blair Marshall, M MARSHALL, Zahoor Ahmed, Zafar Ahmed, John C Kucharczuk, Laurent Kaiser, Larry R Kaiser, Joel Shrager, Joseph B Shrager
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2005 · vol. 27(4) , pp. 662–666 · doi:10.1016/j.ejcts.2004.12.047 · PMID:15784370 · W2127690660
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This study analyzed 24 women with spontaneous pneumothorax, finding catamenial pneumothorax (CP) is common and ineffective hormonal therapies, with gonadotropin-releasing hormone agonists and diaphragmatic intervention being promising management strategies.

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Abstract

OBJECTIVE: To provide further information addressing the etiology, optimal hormonal management and surgical management in catamenial pneumothorax (CP). METHODS: We retrospectively analyzed records of all female patients operated on for spontaneous pneumothorax at a university hospital between January 1993 and March 2002. RESULTS: In eight of 24 patients, pneumothoraces were timed with menses. In all, the right side was involved. Seven patients were on hormonal medications pre-operatively and six post-operatively. All six patients taking estrogen/progesterone replacement had recurrences pre-operatively and two of three had recurrences post-operatively while on these medications. No patient suffered a pneumothorax either pre- or post-operatively while taking a gonadotropin releasing hormone agonist (two and three patients, respectively). Intraoperative findings included diaphragmatic implants [5] diaphragmatic fenestrations [4], apical blebs [2] and visceral pleural implants [2]. All pathology was specifically addressed at the time of surgery. Pleural space management included mechanical pleurodesis in seven and pleurectomy with talc insufflation in 1. Follow-up ranged from 27 to 63 months with a mean of 48 months. Three patients developed post-operative recurrences. One was managed without intervention and two required additional procedures. CONCLUSION: Catamenial pneumothorax is under appreciated, representing up to one-third of women with spontaneous pneumothorax. Hormonal agents that allow for menses are ineffective. Gonadotropin releasing hormone agonists should be considered as part of the pre-operative or post-operative management in high risk patients. Our findings suggest that an additional intervention to augment pleural symphysis at the level of the diaphragm should be performed.

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Condition tags

endometriosis

MeSH descriptors

Hormone Replacement Therapy Menstruation Pneumothorax Pneumothorax Adult Endometriosis Endometriosis Endometriosis Female Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Hormone Replacement Therapy Humans Pneumothorax Pneumothorax Recurrence Retrospective Studies Thoracic Surgery, Video-Assisted Thoracic Surgery, Video-Assisted

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