Catamenial Pneumothorax

Catamenial Pneumothorax Kiyoshi Shikino, MD, PhD, Yoshiyuki Ohira, MD, PhD, and Masatomi Ikusaka, MD, PhD Department of General Medicine, Chiba University Hospital, Chiba-city, Chiba pref., Japan. KEY WORDS: blueberry spots; catamenial; pneumothorax. JG e nI n t e r nM e d3 1 ( 1 0 ) : 1 2 6 0 DOI: 10.1007/s11606-016-3674-6 © Society of General Internal Medicine 2016 A 46-year-old woman presented with 3 days of dyspnea and right-sided pleuritic chest pain. She mentioned sev- en prior episodes of mild shortness of breath and right-sided pleuritic chest pain occurring within 48 hours of menstruation onset. Physical examination revealed tachypnea and decreased lung sounds on the right, with hyper-resonance on percussion. Chest radiograph showed a collapsed right lung (Fig. 1). Lab- oratory tests revealed high levels of cancer antigen-125, sug- gesting endometriosis. Thoracoscopy showed multiple dia- phragmatic blueberry spots at the periphery of the central tendon’s right leaflet (Fig. 2). The patient was diagnosed with catamenial pneumothorax. She underwent video-assisted thoracoscopic surgery and hormonal therapy with danazol. After 5 years, there has been no clinical evidence of recurrence. Catamenial pneumothorax, which affects women of repro- ductive age and occurs within 72 h of menstruation onset, 1 is the most common manifestation of thoracic endometriosis. The right side is involved in the majority of cases. 2 Endometrial implants are visualized as blueberry spots on the pleurodiaphragmatic surface. A combination of video-assisted thoracoscopic surgery and hormonal therapy (gonadotropin- releasing hormone analogs, danazol or aromatase inhibitors for 6 to 12 months) is the preferred approach for treatment and prevention. 3,4 Corresponding Author: Kiyoshi Shikino, MD, PhD; Department of General MedicineChiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba pref., Japan (e-mail: [email protected]). Compliance with Ethical Standards: Conflict of Interest: The authors declare that they do not have a conflict of interest. REFERENCES 1. Peikert T, Gillespie DJ, Cassivi SD. Catamenial pneumothorax. Mayo Clin Proc. 2005;80(5):677–80. 2. Alifano M, Roth T, Broët SC, Schussler O, Magdeleinat P , Regnard JF . Catamenial pneumothorax: a prospective study. Chest. 2003;124(3):1004–8. 3. Attaran S, Bille A, Karenovics W , Lang-Lazdunski L. Videothoracoscopic repair of diaphragm and pleurectomy/abrasion in patients with catamenial pneumothorax: a 9-year experience. Chest. 2013;143(4):1066–9. 4. Azizad-Pinto P , Clarke D. Thoracic endometriosis syndrome: case report and review of the literature. Perm J. 2014;18(3):61 –5. Fig. 1 Chest radiograph shows a collapsed right lung. Received January 25, 2016 Revised February 12, 2016 Accepted March 11, 2016 Published online March 24, 2016 Fig. 2 Thoracoscopy shows multiple diaphragmatic blueberry spots at the periphery of the central tendon ’s right leaflet ( arrows). 1260