Catamenial pneumothorax.

Visouli AN, Aikaterini N. Visouli, Konstantinos Zarogoulidis, Zarogoulidis K, Kougioumtzi I, Ioanna Kougioumtzi, Haidong Huang, Huang H, Li Q, Qiang Li, Dryllis G, Georgios Dryllis, Ioannis Kioumis, Kioumis I, Georgia Pitsiou, Pitsiou G, Machairiotis N, Nikolaos Machairiotis, Katsikogiannis N, Nikolaos Katsikogiannis, Papaiwannou A, Antonis Papaiwannou, Lampaki S, Sofia Lampaki, Bojan Zaric, Bojan Zarić, Zaric B, Branislav Perin, Perin Branislav, Branislav P, Konstantinos Porpodis, Κonstantinos Porpodis, Paul Zarogoulidis, Zarogoulidis P
Journal of thoracic disease · 2014 · vol. 6(Suppl 4) , pp. S448–60 · doi:10.3978/j.issn.2072-1439.2014.08.49 · PMID:25337402 · PMC4203986 · W4300886162
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This paper reviews all aspects of catamenial pneumothorax, a rare condition in women of reproductive age linked to endometriosis, from diagnosis to treatment.

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Abstract

Catamenial pneumothorax (CP) is the most common form of thoracic endometriosis syndrome, which also includes catamenial hemothorax, catamenial hemoptysis, catamenial hemopneumothorax and endometriosis lung nodules, as well as some exceptional presentations. Usually onset of lung collapse is less than 72 hours after menstruation. Most commonly occurs in women aged 30-40 years, but has been diagnosed in young girls as early as 10 years of age and post menopausal women (exclusively in women of menstrual age) most with a history of pelvic endometriosis. Diagnosis can be hinted by high recurrence rates of lung collapse in a woman of reproductive age with endometriosis. Moreover; CA-125 is elevated. Video-assisted thoracoscopy or medical thoracoscopy is used for confirmation. In our current work we will present all aspects of CP from diagnosis to treatment.
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Results

of treatment Surgery for catamenial and/or endometriosis-related pneumothorax has practically zero mortality and no significant morbidity. Recurrence is the most common complication, occurring in 8-40% of patients at a mean follow-up of about 4 years. The high recurrence rates, exceed by far those of surgically treated “idiopathic” pneumothorax (5,6,8,11,13,15,17,20). Alifano et al. reported that among 114 women operated for recurrent spontaneous pneumothorax, the highest postoperative recurrence rate was observed in CP (32%), followed by non-catamenial endometriosis-related pneumothorax (27%), while the recurrence rate was only 5.3% in non-catamenial non endometriosis-related pneumothorax patients, at a mean follow-up of 32.7 months (5). Attaran et al. reported a low recurrence rate (1 in 12, at a mean follow-up of 45.8 months), by video thoracoscopic abrasion/pleurectomy, diaphragmatic repair and PTFE mesh coverage in the presence of diaphragmatic defects, and routine postoperative hormonal treatment (19). Incomplete surgical management of the lesions and/or no adjunctive hormonal treatment in the immediate postoperative period (17,19,20,47-62) may increase the risk of recurrences (20,63-80). Endometriosis-related pneumothorax has been revealed even after hysterectomy and salpingo-oophorectomy for pelvic endometriosis (2,32). Nevertheless, in our opinion, investigation and early treatment of (even asymptomatic) pelvic endometriosis is essential for the prevention of thoracic spread (20).

Conclusions

Disease awareness, early diagnosis, surgical treatment that addresses all thoracic pathology including diaphragmatic repair, and multidisciplinary approach with early postoperative hormonal treatment that deals with the main chronic systemic disease may lead to improved results, mainly reduced recurrence rates of catamenial and/or endometriosis related pneumothorax (3-8,11-13,17,19,20,33).

Acknowledgements

We thank the editor of the Journal of Thoracic Disease (JTD) for granting permission to reprint the figures in included in our relevant article. Disclosure: The authors declare no conflict of interest.

References

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