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Disorders of the Pleura |

Catamenial Pneumothorax: An Unusual Disease Entity

Mona Singh*, MD; Surender Singh, MD; Fadi Safi, MD
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Mercy St Vincent Medical Center, Toledo, OH


Chest. 2012;142(4_MeetingAbstracts):515A. doi:10.1378/chest.1390733
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Abstract

SESSION TYPE: Pleural Student/Resident Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Secondary pneumothorax related to endometriosis has been uncommonly seen in clinical practice. We are reporting a case of recurrent Catamenial pneumothorax in a young female with history of pelvic endometriosis.

CASE PRESENTATION: 41 year old female was admitted to ER with pleuritic chest pain and shortness of breath. Patient was hemodynamically stable without any respiratory distress or evidence of heart failure. Patient was diagnosed with right apical pneumothorax (5%) on chest x-ray which was confirmed by CTA chest. Patient was treated conservatively and pneumothorax was resolved within 24 hours. Six months later, patient again came to ER with similar symptoms and was found to have right apical pneumothorax on chest X-ray (10%). Her symptoms started on her second day of menstrual cycle on both occasions. Patient had a history of laproscopically diagnosed pelvic endometriosis without any hormonal treatment. Pt was diagnosed with recurrent Catamenial pneumothorax and treated conservatively in ER. We discussed the options of hormonal therapy, VATS or open surgery or combined modality with the patient.

DISCUSSION: Catamenial Pneumothorax is a rare disease in ovulating females with a peak age around 35. Recurrent Pneumothorax is common manifestation of thoracic endometriosis occurring in 70 % of cases. Thoracic endometriosis occurs in 2 to 30 % cases of pelvic endometriosis. Presence of pleural endometrial implants is consistent finding in catamenial pneumothorax. Most accepted theory is transdiaphragmatic migration of endometrial cells from pelvis to thorax via diaphragmatic fenestrations. Pneumothorax symptoms are catamenial occurring within 24 to 72 hours of onset of menstruation. Majority are right sided and small to moderate in size. Diagnosis can be made clinically with recurrent history of pneumothorax, temporally associated symptoms with menstruation and history of pelvic endometriosis. Hormonal therapy like oral contraceptives, Danazol, GnRH agonists can be tried initially; however recurrence rate for pneumothorax is more than 50 %. Patients with recurrence usually require surgery with VATS or open procedure for excision of endometrial implants and closure of diaphragmatic defects with mesh. Combined modality with hormonal therapy and surgery has been shown to have better outcomes to prevent recurrences.

CONCLUSIONS: Young females with spontaneous pneumothorax should be evaluated for endometriosis because risk of recurrence of catamenial pneumothorax is much higher and treatment modality in these cases can change the outcome significantly.

1) Catamenial pneumothorax, clinical manifestations--a multidisciplinary challenge. Majak P, Langebrekke A, Hagen OM, Qvigstad E. Pneumonol Alergol Pol. 2011;79(5):347-50.

DISCLOSURE: The following authors have nothing to disclose: Mona Singh, Surender Singh, Fadi Safi

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Mercy St Vincent Medical Center, Toledo, OH

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