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Catamenial pneumothorax revisited: clinical approach and systematic review of the literature.
J Thorac Cardiovasc Surg. 2004 Oct; 128(4):502-8.JT

Abstract

BACKGROUND

Catamenial pneumothorax is a rare entity of spontaneous, recurring pneumothorax in women. It has been associated with thoracic endometriosis, yet varying clinical courses and the lack of consistent intraoperative findings have led to conflicting etiologic theories.

METHODS

We discuss etiology, clinical course, and surgical treatment of 3 women with catamenial pneumothorax. In addition, the world literature since the first description is reviewed.

RESULTS

Three women (31, 32, and 39 years old) had recurrent, menses-associated, right-sided spontaneous pneumothoraces. They had undergone video-assisted thoracoscopic surgery previously, with various unsuccessful procedures. Finally, with video-assisted thoracoscopic surgery multiple small perforations in the tendinous part of the right diaphragm with adjacent endometrial implants were detected. After plication of the involved area, 2 patients have been free of recurrence for 22 and 13 months, respectively. Laparoscopic evaluation in 1 woman with a further recurrence revealed asymptomatic pelvic endometriosis. This patient has been free of recurrence since initiation of luteinizing hormone-releasing hormone analog therapy for 17 months. In a review of 229 cases of catamenial pneumothorax in the literature, adequate information was given for 195 patients (85.2%). One hundred fifty-four (79%) were treated surgically, with detailed findings reported for 140 (91%). Thoracic endometriosis was diagnosed in 73 patients (52.1%), and 54 (38.8%) showed diaphragmatic lesions. Pleurodesis, with or without diaphragmatic repair or wedge resection, was performed in 81.7% of the cases.

CONCLUSIONS

Catamenial pneumothorax may be suspected in ovulating women with spontaneous pneumothorax, even in the absence of symptoms associated with pelvic endometriosis. During video-assisted thoracoscopic surgery, inspection of the diaphragmatic surface is paramount. Plication of the involved area alone can be successful. In complicated cases, hormonal suppression therapy is a helpful adjunct.

Authors+Show Affiliations

Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review
Systematic Review

Language

eng

PubMed ID

15457149

Citation

Korom, Stephan, et al. "Catamenial Pneumothorax Revisited: Clinical Approach and Systematic Review of the Literature." The Journal of Thoracic and Cardiovascular Surgery, vol. 128, no. 4, 2004, pp. 502-8.
Korom S, Canyurt H, Missbach A, et al. Catamenial pneumothorax revisited: clinical approach and systematic review of the literature. J Thorac Cardiovasc Surg. 2004;128(4):502-8.
Korom, S., Canyurt, H., Missbach, A., Schneiter, D., Kurrer, M. O., Haller, U., Keller, P. J., Furrer, M., & Weder, W. (2004). Catamenial pneumothorax revisited: clinical approach and systematic review of the literature. The Journal of Thoracic and Cardiovascular Surgery, 128(4), 502-8.
Korom S, et al. Catamenial Pneumothorax Revisited: Clinical Approach and Systematic Review of the Literature. J Thorac Cardiovasc Surg. 2004;128(4):502-8. PubMed PMID: 15457149.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Catamenial pneumothorax revisited: clinical approach and systematic review of the literature. AU - Korom,Stephan, AU - Canyurt,Haydar, AU - Missbach,Antje, AU - Schneiter,Didier, AU - Kurrer,Michael Odo, AU - Haller,Urs, AU - Keller,Paul J, AU - Furrer,Markus, AU - Weder,Walter, PY - 2004/10/1/pubmed PY - 2004/12/16/medline PY - 2004/10/1/entrez SP - 502 EP - 8 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 128 IS - 4 N2 - BACKGROUND: Catamenial pneumothorax is a rare entity of spontaneous, recurring pneumothorax in women. It has been associated with thoracic endometriosis, yet varying clinical courses and the lack of consistent intraoperative findings have led to conflicting etiologic theories. METHODS: We discuss etiology, clinical course, and surgical treatment of 3 women with catamenial pneumothorax. In addition, the world literature since the first description is reviewed. RESULTS: Three women (31, 32, and 39 years old) had recurrent, menses-associated, right-sided spontaneous pneumothoraces. They had undergone video-assisted thoracoscopic surgery previously, with various unsuccessful procedures. Finally, with video-assisted thoracoscopic surgery multiple small perforations in the tendinous part of the right diaphragm with adjacent endometrial implants were detected. After plication of the involved area, 2 patients have been free of recurrence for 22 and 13 months, respectively. Laparoscopic evaluation in 1 woman with a further recurrence revealed asymptomatic pelvic endometriosis. This patient has been free of recurrence since initiation of luteinizing hormone-releasing hormone analog therapy for 17 months. In a review of 229 cases of catamenial pneumothorax in the literature, adequate information was given for 195 patients (85.2%). One hundred fifty-four (79%) were treated surgically, with detailed findings reported for 140 (91%). Thoracic endometriosis was diagnosed in 73 patients (52.1%), and 54 (38.8%) showed diaphragmatic lesions. Pleurodesis, with or without diaphragmatic repair or wedge resection, was performed in 81.7% of the cases. CONCLUSIONS: Catamenial pneumothorax may be suspected in ovulating women with spontaneous pneumothorax, even in the absence of symptoms associated with pelvic endometriosis. During video-assisted thoracoscopic surgery, inspection of the diaphragmatic surface is paramount. Plication of the involved area alone can be successful. In complicated cases, hormonal suppression therapy is a helpful adjunct. SN - 0022-5223 UR - https://www.unboundmedicine.com/medline/citation/15457149/Catamenial_pneumothorax_revisited:_clinical_approach_and_systematic_review_of_the_literature_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S002252230400772X DB - PRIME DP - Unbound Medicine ER -