To evaluate clinical characteristics, pathological diagnoses and outcomes of spontaneous pneumothoraces occurring in women referred for surgery.
Clinical files of all the women referred to our hospital during a 19-year period (from January 1990 to April 2009) for surgical treatment of spontaneous pneumothorax were retrospectively reviewed. Catamenial pneumothorax was defined as recurrent pneumothorax occurring between the day before and within 72 hours after the onset of menses.
Fifty four women underwent surgical treatment. Nine women (16.6%) had catamenial pneumothorax. Pneumothorax was right-sided in four, left-sided in three and simultaneous bilateral in two out of nine catamenial cases. For comparison, among forty five women with non-catamenial pneumothorax, twenty one was right-sided, twenty four was left-sided and none was simultaneous bilateral presentation. Only one woman with catamenial pneumothorax was a smoker, and six women with non-catamenial pneumothorax were smokers. Mean age at first consultation to our institution was 26.4 in catamenial and 35.2 in non-catamenial. Pathological examination was performed in all catamenial and 37/45 non-catamenial pneumothoraces. Histological diagnosis of catamenial pneumothorax was endometriosis of the diaphragm in two cases, lymphangioleiomyomatosis in two cases, bullae or blebs in three cases, hematoma in one cases and pulmonary capillary hemangiomatosis-like foci in two cases. On the other hand, pathological investigation revealed bullae or emphysematous change in 33 (Birt-Hogg-Dube syndrome was diagnosed in one), endometriosis of the diaphragm in one, tuberculosis in one, postpneumonic scar in one and inflammation in one of 37 non-catamenial pneumothorax. There was no postoperative death. Recurrence rates in catamenial and non-catamenial pneumothoraces were 56% and 27%, respectively.
Our experience shows that catamenial pneumothorax accounts for important part of pneumothorax in woman referred for surgery as previously reported by other study groups. There was slight right-sided predominance in catamenial pneumothoraces, but no predilection of laterality was observed in non-catamenial cases. High recurrence rate (especially of catamenial pneumothorax) should cause difficulty in medical treatment and management.
Spontaneous pneumothorax in woman should be treated and managed more carefully.
Tomohito Saito, No Financial Disclosure Information; No Product/Research Disclosure Information