Catamenial pneumothorax

Alifano M, Marco Alifano
Current opinion in pulmonary medicine · 2010 · vol. 16(4) , pp. 381–386 · doi:10.1097/mcp.0b013e32833a9fc2 · PMID:20473170 · W4237474000
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Catamenial pneumothorax, often linked to endometriosis found on the diaphragm or pleura, is best managed with video-assisted thoracic surgery followed by medical ovarian suppression.

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This review synthesizes current knowledge on catamenial pneumothorax, a condition previously considered rare but now recognized as accounting for approximately one-third of spontaneous pneumothoraces in women requiring surgery. Video-assisted thoracic surgery typically reveals diaphragmatic defects and nodules, with pathology confirming endometriosis in most cases, supporting the theory that air passes transabdominally through the diaphragm. Management involves surgical intervention to confirm diagnosis and address pathogenic mechanisms, followed by mandatory medical therapy for ovarian rest to ensure treatment success. This paper is centrally about endometriosis — specifically its manifestation as thoracic endometriosis syndrome causing catamenial pneumothorax.

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Abstract

PURPOSE OF REVIEW: Although known for several decades, catamenial pneumothorax has been considered until recently as an extremely rare entity. The condition is now more easily recognized and several studies have been published, with somewhat relevant discrepancies with respect to etiologic, epidemiologic, and management features. In the present review, I will provide a synthesis of available knowledge on the subject. RECENT FINDINGS: Catamenial pneumothorax accounts for approximately one third of cases of spontaneous pneumothoraces in women referred for surgery. At video-assisted thoracic surgery, diaphragmatic defects and nodules are the most frequent findings. Pathology shows endometriosis in most instances. Endometrial implants in visceral pleura are also found, although less frequently. Findings of surgical explorations support the theory of transabdominal-transdiaphragmatic passage of air to explain the pathogenesis of catamenial pneumothorax. SUMMARY: Management of patients with catamenial pneumothorax implies surgery, if possible by video-assisted technology, to obtain samples for pathologic confirmation of endometriosis and to treat the main pathogenic mechanisms of pneumothorax. Partial diaphragmatic resection and/or exeresis of visceral pleural implants, as well as talc pleurodesis, are nowadays frequently carried out. Medical therapy to achieve ovarian rest is mandatory in the postoperative period, the multimodality management being the key to treatment success in this condition.
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Catamenial pneumothorax - Marco Alifano Purpose of review Although known for several decades, catamenial pneumothorax has been considered until recently as an extremely rare entity. The condition is now more easily recognized and several studies have been published, with somewhat relevant discrepancies with respect to etiologic, epidemiologic, and management features. In the present review, I will provide a synthesis of available knowledge on the subject. Recent findings Catamenial pneumothorax accounts for approximately one third of cases of spontaneous pneumothoraces in women referred for surgery. At video-assisted thoracic surgery, diaphragmatic defects and nodules are the most frequent findings. Pathology shows endometriosis in most instances. Endometrial implants in visceral pleura are also found, although less frequently. Findings of surgical explorations support the theory of transabdominal–transdiaphragmatic passage of air to explain the pathogenesis of catamenial pneumothorax. Summary Management of patients with catamenial pneumothorax implies surgery, if possible by video-assisted technology, to obtain samples for pathologic confirmation of endometriosis and to treat the main pathogenic mechanisms of pneumothorax. Partial diaphragmatic resection and/or exeresis of visceral pleural implants, as well as talc pleurodesis, are nowadays frequently carried out. Medical therapy to achieve ovarian rest is mandatory in the postoperative period, the multimodality management being the key to treatment success in this condition.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Pneumothorax Pneumothorax Diaphragm Diaphragm Diaphragm Endometriosis Endometriosis Female Humans Pleura Pleura Pleura Pleurodesis Pneumothorax Pneumothorax Risk Factors Thoracic Surgery, Video-Assisted

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