Tags

Type your tag names separated by a space and hit enter

Catamenial pneumothorax: a rare entity? Report of 5 cases and review of the literature.
J Thorac Dis 2012; 4 Suppl 1:17-31JT

Abstract

OBJECTIVE

Spontaneous recurrent pneumothorax during menstruation is reported as catamenial pneumothorax. It is encountered in 3-6% of spontaneous pneumothorax cases among menstruating women. The percentage among women referred for surgery is significantly higher (25-30%). Although it usually involves the right-side (85-95%) it can be left-sided or bilateral. It is associated with diaphragmatic perforations and/or thoracic endometriosis. There is pelvic endometriosis in up to 30-51% of cases. The lesions that are not always found may present as small or larger holes at the central tendon of the diaphragm, as red, blueberry, brown spots or larger nodules at the diaphragm, the visceral or parietal pleura. Lesion histology may reveal endometriosis. We present 5 cases of catamenial pneumothorax treated surgically during the last 6 years.

PATIENTS AND METHODS

Five women, with a mean age of 34+/-9.9 years (median 38, range, 19-45 years) presented with right-sided recurrent catamenial pneumothorax. In 3 patients diaphragmatic perforation(s) were found; perforation suturing (n=1), and diaphragmatic plication reinforced with bovine pericardial patch (n=1) were performed. All patients underwent atypical resection of upper and/or middle lobe segments of lung parenchyma that appeared abnormal (haemorrhagic/emphysematous or blebs). Four patients underwent pleurodesis and 1 patient underwent pleurectomy. Four interventions were performed through video assisted thoracoscopic surgery, while diaphragmatic plication was performed through a video assisted mini-thoracotomy. Histology did not reveal endometriosis tissue.

RESULTS

The postoperative course was uneventful. The patients were extubated in theatre and were discharged home at a mean of 7+/-4 days (median 6 days, range, 4-14 days). Two of them received hormonal therapy [Gonadotropin Releasing Hormone (GnRH) analogue] postoperatively. At a follow-up of 14.16 patient-years (mean 2.83+/-1.08 years, range, 1.33-3.83 years) there was recurrence, 6.5 months postoperatively, in one patient that had not undergone closure of a tiny diaphragmatic hole and had not received hormonal treatment postoperatively. She was treated medically (amenorrhea for 6 months with GnRH analogue) and had no further recurrences (in 3.3 years).

CONCLUSIONS

Surgery is the treatment of choice of catamenial pneumothorax. It should aim to complete management of all lesions. The most common complication is recurrence. Early diagnosis and multidisciplinary treatment including hormonal therapy may be beneficial in high risk patients.

Authors+Show Affiliations

Cardiothoracic Department, St Luke's Hospital, Panorama, Thessaloniki, Greece;No affiliation info availableNo affiliation info availableNo 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)

Journal Article

Language

eng

PubMed ID

23304438

Citation

Visouli, Aikaterini N., et al. "Catamenial Pneumothorax: a Rare Entity? Report of 5 Cases and Review of the Literature." Journal of Thoracic Disease, vol. 4 Suppl 1, 2012, pp. 17-31.
Visouli AN, Darwiche K, Mpakas A, et al. Catamenial pneumothorax: a rare entity? Report of 5 cases and review of the literature. J Thorac Dis. 2012;4 Suppl 1:17-31.
Visouli, A. N., Darwiche, K., Mpakas, A., Zarogoulidis, P., Papagiannis, A., Tsakiridis, K., ... Zarogoulidis, K. (2012). Catamenial pneumothorax: a rare entity? Report of 5 cases and review of the literature. Journal of Thoracic Disease, 4 Suppl 1, pp. 17-31. doi:10.3978/j.issn.2072-1439.2012.s006.
Visouli AN, et al. Catamenial Pneumothorax: a Rare Entity? Report of 5 Cases and Review of the Literature. J Thorac Dis. 2012;4 Suppl 1:17-31. PubMed PMID: 23304438.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Catamenial pneumothorax: a rare entity? Report of 5 cases and review of the literature. AU - Visouli,Aikaterini N, AU - Darwiche,Kaid, AU - Mpakas,Andreas, AU - Zarogoulidis,Paul, AU - Papagiannis,Antonios, AU - Tsakiridis,Kosmas, AU - Machairiotis,Nikolaos, AU - Stylianaki,Aikaterini, AU - Katsikogiannis,Nikolaos, AU - Courcoutsakis,Nicolaos, AU - Zarogoulidis,Konstantinos, PY - 2012/10/14/received PY - 2012/11/23/accepted PY - 2013/1/11/entrez PY - 2013/1/11/pubmed PY - 2013/1/11/medline KW - Catamenial pneumothorax KW - thoracic endometriosis KW - video-assisted thoracoscopic surgery SP - 17 EP - 31 JF - Journal of thoracic disease JO - J Thorac Dis VL - 4 Suppl 1 N2 - OBJECTIVE: Spontaneous recurrent pneumothorax during menstruation is reported as catamenial pneumothorax. It is encountered in 3-6% of spontaneous pneumothorax cases among menstruating women. The percentage among women referred for surgery is significantly higher (25-30%). Although it usually involves the right-side (85-95%) it can be left-sided or bilateral. It is associated with diaphragmatic perforations and/or thoracic endometriosis. There is pelvic endometriosis in up to 30-51% of cases. The lesions that are not always found may present as small or larger holes at the central tendon of the diaphragm, as red, blueberry, brown spots or larger nodules at the diaphragm, the visceral or parietal pleura. Lesion histology may reveal endometriosis. We present 5 cases of catamenial pneumothorax treated surgically during the last 6 years. PATIENTS AND METHODS: Five women, with a mean age of 34+/-9.9 years (median 38, range, 19-45 years) presented with right-sided recurrent catamenial pneumothorax. In 3 patients diaphragmatic perforation(s) were found; perforation suturing (n=1), and diaphragmatic plication reinforced with bovine pericardial patch (n=1) were performed. All patients underwent atypical resection of upper and/or middle lobe segments of lung parenchyma that appeared abnormal (haemorrhagic/emphysematous or blebs). Four patients underwent pleurodesis and 1 patient underwent pleurectomy. Four interventions were performed through video assisted thoracoscopic surgery, while diaphragmatic plication was performed through a video assisted mini-thoracotomy. Histology did not reveal endometriosis tissue. RESULTS: The postoperative course was uneventful. The patients were extubated in theatre and were discharged home at a mean of 7+/-4 days (median 6 days, range, 4-14 days). Two of them received hormonal therapy [Gonadotropin Releasing Hormone (GnRH) analogue] postoperatively. At a follow-up of 14.16 patient-years (mean 2.83+/-1.08 years, range, 1.33-3.83 years) there was recurrence, 6.5 months postoperatively, in one patient that had not undergone closure of a tiny diaphragmatic hole and had not received hormonal treatment postoperatively. She was treated medically (amenorrhea for 6 months with GnRH analogue) and had no further recurrences (in 3.3 years). CONCLUSIONS: Surgery is the treatment of choice of catamenial pneumothorax. It should aim to complete management of all lesions. The most common complication is recurrence. Early diagnosis and multidisciplinary treatment including hormonal therapy may be beneficial in high risk patients. SN - 2072-1439 UR - https://www.unboundmedicine.com/medline/citation/23304438/Catamenial_pneumothorax:_a_rare_entity_Report_of_5_cases_and_review_of_the_literature_ L2 - https://doi.org/10.3978/j.issn.2072-1439.2012.s006 DB - PRIME DP - Unbound Medicine ER -