Catamenial pneumothorax complicated by massive right diaphragmatic hernia with solid organ herniation

Supakorn Srihattapadungkit, Srihattapadungkit S, Klein Dantis, Dantis K, Yu J, Jakraphan Yu, Sira Laohathai, Laohathai S
Pneumologie (Stuttgart, Germany) · 2026 · doi:10.1055/a-2882-7406 · PMID:42409048 · W7167459371
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-07-17 ⓘ

This case report describes a massive right diaphragmatic hernia with solid organ herniation presenting as catamenial pneumothorax, successfully treated with surgical repair and hormonal suppression.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-17 · read from full text ⓘ

The paper reports a late-40s woman with acute right-sided chest pain beginning one day before menstruation, ultimately diagnosed with catamenial pneumothorax complicated by a massive right diaphragmatic defect and herniation of the entire right hepatic lobe, gallbladder, and upper pole of the right kidney into the thoracic cavity. After initial imaging showed a right pneumothorax that resolved with intercostal drainage, computed tomography revealed the advanced diaphragmatic pathology, and the authors used a multidisciplinary surgical approach with abdominal reduction followed by video-assisted thoracoscopic mesh repair and talc pleurodesis, plus postoperative hormonal suppression. The patient remained asymptomatic with no recurrence at 18 months, and the case format limits generalizability beyond this individual presentation. This paper is centrally about endometriosis — it describes a rare thoracic endometriosis manifestation (catamenial pneumothorax) with extensive diaphragmatic involvement.

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Abstract

Catamenial pneumothorax is an uncommon manifestation of thoracic endometriosis syndrome, usually associated with small right-sided diaphragmatic fenestration. We report an extreme presentation in a woman in her late 40s who developed acute right-sided chest pain one day prior to menstruation. Initial imaging revealed a right pneumothorax, which resolved after intercostal drainage. However, subsequent computed tomography revealed a massive defect in the right hemidiaphragm with herniation of the entire right hepatic lobe, gallbladder, and upper pole of the right kidney into the thoracic cavity. A multidisciplinary surgical strategy was adopted, involving abdominal reduction of the herniated viscera, followed by video-assisted thoracoscopic mesh repair of the diaphragm and talc pleurodesis. Postoperative hormonal suppression was initiated. The patient remained asymptomatic without recurrence at 18 months. This case highlights that catamenial pneumothorax may represent advanced chronic diaphragmatic pathology, even at the first clinical presentation.
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Abstract

Catamenial pneumothorax is an uncommon manifestation of thoracic endometriosis syndrome, usually associated with small right-sided diaphragmatic fenestration. We report an extreme presentation in a woman in her late 40s who developed acute right-sided chest pain one day prior to menstruation. Initial imaging revealed a right pneumothorax, which resolved after intercostal drainage. However, subsequent computed tomography revealed a massive defect in the right hemidiaphragm with herniation of the entire right hepatic lobe, gallbladder, and upper pole of the right kidney into the thoracic cavity. A multidisciplinary surgical strategy was adopted, involving abdominal reduction of the herniated viscera, followed by video-assisted thoracoscopic mesh repair of the diaphragm and talc pleurodesis. Postoperative hormonal suppression was initiated. The patient remained asymptomatic without recurrence at 18 months. This case highlights that catamenial pneumothorax may represent advanced chronic diaphragmatic pathology, even at the first clinical presentation. Zusammenfassung Katamenialer Pneumothorax ist eine seltene Erscheinung des Thorax-Endometriose-Syndroms, die normalerweise mit kleinen fenestrierten Defekten im rechten Zwerchfell verbunden ist. Wir berichten über eine extreme Ausprägung bei einer Patientin im fünften Lebensjahrzehnt, die einen Tag vor der Menstruation akute Schmerzen auf der rechten Brustseite entwickelte. Erste bildgebende Untersuchungen zeigten einen rechten Pneumothorax, der nach interkostaler Drainage behoben wurde. Eine anschließende Computertomografie zeigte jedoch einen massiven Defekt im rechten Hemidiaphragma mit Herniation des gesamten rechten Leberlappens, der Gallenblase und des oberen Pols der rechten Niere in die Thoraxhöhle. Eine multidisziplinäre chirurgische Strategie wurde angewendet, die eine abdominale Reduktion der Hernienorgane, gefolgt von einer videounterstützten thorakoskopischen Netzreparatur des Zwerchfells und einer Talkpleurodese umfasste. Postoperativ wurde eine hormonelle Suppression eingeleitet. Die Patientin blieb 18 Monate lang asymptomatisch ohne Rezidiv. Dieser Fall zeigt, dass ein katamenialer Pneumothorax bereits bei der ersten klinischen Präsentation Ausdruck einer fortgeschrittenen chronischen Zwerchfellpathologie sein kann. Publication History Received: 08 April 2026 Accepted after revision: 19 May 2026 Article published online: 06 July 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany -

References

- 1 Damps-Konstańska I, Szukalska A, Janowiak P. et al. Catamenial Pneumothorax-Still an Unveiled Disease. Medicina (Kaunas) 2024; 60: 2029 - 2 Kardaman N, Nizami M, Marciniak S. et al. Catamenial pneumothorax. Ann R Coll Surg Engl 2022; 104: e109-e112 - 3 Bricelj K, Srpčič M, Ražem A. et al. Catamenial pneumothorax since introduction of video-assisted thoracoscopic surgery: A systematic review. Wien Klin Wochenschr 2017; 129: 717-726 - 4 Arakawa S, Matsudaira H, Noda Y. et al. Catamenial pneumothorax with partial liver herniation due to diaphragmatic laceration: a case report and literature review. J Cardiothorac Surg 2021; 16: 23 - 5 Visouli AN, Darwiche K, Mpakas A. et al. Catamenial pneumothorax: a rare entity? Report of 5 cases and review of the literature. J Thorac Dis 2012; 4: 17-31 - 6 Bricelj K, Srpčič M, Ražem A. et al. Catamenial pneumothorax since introduction of video-assisted thoracoscopic surgery: A systematic review. Wien Klin Wochenschr 2017; 129: 717-726 - 7 Leong AC, Coonar AS, Lang-Lazdunski L. Catamenial pneumothorax: surgical repair of the diaphragm and hormone treatment. Ann R Coll Surg Engl 2006; 88: 547-549 - 8 Ciriaco P, Negri G, Libretti L. et al. Surgical treatment of catamenial pneumothorax: a single centre experience. Interact Cardiovasc Thorac Surg 2009; 8: 349-352 - 9 Laohathai S, Wannadilok P, Poopipatpab S. et al. Nonintubated Video-assisted thoracoscopic surgery using local anesthesia for catamenial pneumothorax. Ann Thorac Surg 2021; 111: e245-e246

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