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Disorders of the Pleura |

Catamenial Pneumothorax: Surgical Approach and Technique for Prevention

M. Teresa Gómez-Hernández, MD; Maria Rodríguez, MD; Marcelo Fernando Jiménez López, PhD; Nuria María Novoa Valentín, PhD; Jose Luis Aranda Alcaide, PhD; Gonzalo Varela Simó, PhD
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Salamanca University Hospital, Salamanca, Spain


Chest. 2014;145(3_MeetingAbstracts):283A. doi:10.1378/chest.1824422
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Abstract

SESSION TITLE: Pleural Disease/Pneumothorax Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Catamenial pneumothorax is a rare disorder characterized by recurrent spontaneous pneumothorax in women of reproductive age occurring in conjunction with the menstrual cycle. They have a high rate of recurrence and treatment failure. Here, we present our surgical experience during the last 10 years.

METHODS: A retrospective review of a prospectively recorded database of all patients who underwent surgical treatment for catamenial pneumothorax from May 2003 to July 2013 was performed.

RESULTS: During the study period, 10 patients underwent surgical treatment for catamenial pneumothorax. The mean age was 36,2 ± 4,57 (median 34, range 31-45 years). All of them presented with right-sided recurrent pneumothorax. In 9 patients diaphragmatic perforations were found in the operative field. Two patients underwent atypical segmentectomy plus pleural abrasion and one patient underwent chemical pleurodesis plus sealant application on the diaphragmatic lesions. These three patients had several recurrences within the first year of follow-up and they were treated surgically placing a mesh to cover the lesion site in the diaphragm. No further recurrences happened. The only patient who did not have diaphragmatic holes showed endometriosis tissue in the upper lobe segments of lung and she underwent atypical resection plus chemical pleurodesis. Three more patients underwent pleurodesis involving polyglactin absorbable mesh to cover the diaphragm plus pleural abrasion and in three cases an additional mesh was placed dressing the lung also. None of these seven cases had any recurrence. All interventions were performed through video assisted thoracoscopic surgery. After the surgery all patients received hormonal therapy (gonadotropin releasing hormone analogue) for three months.

CONCLUSIONS: Surgery is the treatment of choice for catamenial pneumothorax. The aim of the surgical treatment is promoting pleurodesis to prevent recurrence. In our experience, mechanical pleurodesis based on diaphragmatic mesh combined with pleural abrasion or an additional mesh dressing the lung are effective operative methods that facilitate pleural adhesion for secondary prevention.

CLINICAL IMPLICATIONS: Catamenial pneumothoraces have a high rate of recurrence when managed by various existing treatment approaches. We believe that this method has proved to be effective and valid for the treatment of recurrent catamenial pneumothorax.

DISCLOSURE: The following authors have nothing to disclose: M. Teresa Gómez-Hernández, Maria Rodríguez, Marcelo Fernando Jiménez López, Nuria María Novoa Valentín, Jose Luis Aranda Alcaide, Gonzalo Varela Simó

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