Recurrent spontaneous pneumothorax in young woman: catamenial pneumothorax.

Adriá Rosat, Rosat A, Herrero J, Jorge Herrero
The Pan African medical journal · 2016 · vol. 23 , pp. 44 · doi:10.11604/pamj.2016.23.44.8877 · PMID:27217870 · PMC4862766 · W2283535500
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This case report describes a young woman with recurrent pneumothorax linked to pelvic endometriosis, who successfully underwent surgical intervention and is now symptom-free.

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This case report describes a 31-year-old non-smoking woman presenting with recurrent spontaneous right-sided hemopneumothorax and dyspnea. Initial thoracoscopic resection of apical blebs failed to prevent recurrence, which continued in association with her menstrual cycle, prompting further gynecologic evaluation that confirmed pelvic endometriosis. The patient subsequently underwent bilateral salpingectomy and partial oophorectomy, followed by pleurodesis for persistent air leaks, resulting in the resolution of pneumothorax episodes over one year. This paper is centrally about endometriosis — specifically its manifestation as catamenial pneumothorax, where diaphragmatic or pleural implants are suspected despite negative histology in this instance.

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Abstract

A 31-old-year woman came to hospital for dyspnea. She was a non smoker patient and had no history of previous pneumothorax. She was under gynecologic study for having troubles to get pregnant. On physical examination she had tachypnea and right chest hypoventilation. Blood test showed slight leukocytosis and chest x-ray revealed a right hemopneumothorax. A chest tube was placed and few days later she required surgery for persistent air leak. Apical blebs were found and resected by video thoracoscopy. Gynecologic studies were completed and she was diagnosed of pelvic endometriosis and treated by bilateral salpingectomy and left partial oophorectomy with confirmed endometriosis on pathology. She had three more episodes of smaller right pneumothorax in relation with menses. On the last episode she underwent surgery to perform a pleurodesis. Small tissue implants were resected, which were negative for endometriosis. One year later she has had no more episodes and she is actually under in vitro fertilization procedures to get pregnant. Catamenial pneumothorax is related with up to 3% of spontaneous pneumothorax in women, and should be considered as differential diagnosis, especially in those with troubles to get pregnant.
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A 31-old-year woman came to hospital for dyspnea. She was a non smoker patient and had no history of previous pneumothorax. She was under gynecologic study for having troubles to get pregnant. On physical examination she had tachypnea and right chest hypoventilation. Blood test showed slight leukocytosis and chest x-ray revealed a right hemopneumothorax. A chest tube was placed and few days later she required surgery for persistent air leak. Apical blebs were found and resected by video thoracoscopy. Gynecologic studies were completed and she was diagnosed of pelvic endometriosis and treated by bilateral salpingectomy and left partial oophorectomy with confirmed endometriosis on pathology. She had three more episodes of smaller right pneumothorax in relation with menses. On the last episode she underwent surgery to perform a pleurodesis. Small tissue implants were resected, which were negative for endometriosis. One year later she has had no more episodes and she is actually under in vitro fertilization procedures to get pregnant. Catamenial pneumothorax is related with up to 3% of spontaneous pneumothorax in women, and should be considered as differential diagnosis, especially in those with troubles to get pregnant. Right chest hemopneumothorax

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endometriosis

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