A case report of recurrent catamenial pneumothorax treated with GnRH analogue

Kenji Tsuboshima, Wataru Nishio, Kazuya Uchino, Hiroaki Harada, Toshihiko Sakamoto, Morihito Okada, Noriaki Tsubota
In: The Journal of the Japanese Associtation for Chest Surgery · 2005 · vol. 19(4) , pp. 576–580 · doi:10.2995/jacsurg.19.576 · W1971370777
article OA: bronze CC0 ⤵ 3 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This case report describes a 45-year-old woman with recurrent catamenial pneumothorax, initially treated with a GnRH analogue, who subsequently underwent successful surgical resection of diaphragmatic defects.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This case report describes a 45-year-old woman with recurrent catamenial pneumothorax whose symptoms repeatedly occurred in synchrony with her menstrual cycle despite initial thoracic drainage and subsequent LHRH (GnRH) agonist hormone therapy. Although the pneumothorax improved temporarily, it recurred three months later even after menstrual cessation, leading the authors to proceed with video-assisted thoracoscopic surgery that found two diaphragmatic holes and a thinned area, which were resected and sutured. The patient had no pneumothorax recurrence for 1 year and 2 months after surgery, and the authors note that review of 45 Japanese cases since 2000 found right-sided cases uniformly involved diaphragmatic lesions, supporting VATS as a first-choice approach, though this conclusion is based on case reports rather than controlled data. This paper is centrally about endometriosis — it reports catamenial (menstrual-associated) pneumothorax treated with a GnRH analogue and surgery, a condition commonly linked to thoracic endometriosis.

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Abstract

ホルモン療法に抗し再発を来した月経随伴性気胸に対し, 外科的治療が奏効した1例を経験したので報告する.症例は45歳の女性. 右気胸の診断で胸腔ドレナージを施行されたが, 改善傾向なく当科へ紹介入院となった. 月経周期に一致する発症を繰り返していたため月経随伴性気胸と診断し, LHRHアゴニストによるホルモン療法を開始した. 一時, 気胸は改善したが, その後の月経停止にもかかわらず3ヵ月目に再発を認めたため, 保存的治療の限界と考え胸腔鏡補助下に手術を施行した. 横隔膜に2ヵ所の小孔と菲薄部を認め, 同部を切除縫縮した. 術後はホルモン療法を中止しているが, 1年2ヵ月後の現在まで気胸の再発は認めていない. 2000年以降, 自験例を含む本邦報告例45例の検討においても右側発症症例は全例に横隔膜病変が指摘されており, 胸腔鏡補助下手術を第一選択とすべきと考えられる.

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