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What About Having a Hydropneumothorax Every Month?
Rev Port Cir Cardiotorac Vasc 2017 Jul-Dec; 24(3-4):145RP

Abstract

INTRODUCTION

Endometriosis is a pathological, benign, inflammatory condition characterized by the presence of endometrial glands and stroma outside the uterine cavity, typically in the pelvis. In rare conditions, this estrogen-dependent disease may be extrapelvic, presenting with a variety of symptoms, including Thoracic Endometriosis.

METHODS

A 37 year-old woman presented with her third right hydropneumothorax in three months. Her medical history included infertility, an ovarian mass (in study), biliary diskinesia and protein C deficiency. The CT showed a bleb in the right inferior lobe and a pleural effusion. A detailed clinical history revealed a temporal relationship of the hydropneumothoraxes and her menses.

RESULTS

She underwent a videothoracoscopy: there were macroscopic tissue alterations all over the parietal and visceral pleura. We performed a biopsy of one of those spots (of the parietal pleura) and an atypical resection of the apex of the apical segment of the right inferior lobe, where the bleb was. A talc pleurodesis was also performed. The patient was discharged at day 1 and is currently under regular follow-up in ambulatory, with no recurrent pneumothoraxes for two months. The histopathology was compatible with a pleural Endometriosis.

CONCLUSION

Thoracic endometriosis is a clinical diagnosis, although the histopathologic confirmation is preferred (but not necessary): it should be suspected in reproductive age women who present with hemothorax, pneumothorax, hemoptysis, chest or scapular pain, lung nodules or diaphragmatic rupture perimenstrually, especially right-sided. Most commonly it presents as catamenial pneumothorax and/or hemothorax. Those with high clinical suspicion and/ or imaging supportive of the diagnosis, should undergo an interventional procedure (thoracoscopy), both for diagnose and management. Primary treatment is chest tube drainage. Prevention of recurrence can be medical (hormonal suppression) or surgical (lung resection, pleurectomy, pleurodesis).

Authors+Show Affiliations

Centro Hospitalar São João, Portugal.Centro Hospitalar São João, Portugal.Centro Hospitalar São João, Portugal.Centro Hospitalar São João, Portugal.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29701376

Citation

Lopes, Sara, et al. "What About Having a Hydropneumothorax Every Month?" Revista Portuguesa De Cirurgia Cardio-toracica E Vascular : Orgao Oficial Da Sociedade Portuguesa De Cirurgia Cardio-Toracica E Vascular, vol. 24, no. 3-4, 2017, p. 145.
Lopes S, Maciel J, Cabral Bastos P, et al. What About Having a Hydropneumothorax Every Month? Rev Port Cir Cardiotorac Vasc. 2017;24(3-4):145.
Lopes, S., Maciel, J., Cabral Bastos, P., & Pinho, P. (2017). What About Having a Hydropneumothorax Every Month? Revista Portuguesa De Cirurgia Cardio-toracica E Vascular : Orgao Oficial Da Sociedade Portuguesa De Cirurgia Cardio-Toracica E Vascular, 24(3-4), p. 145.
Lopes S, et al. What About Having a Hydropneumothorax Every Month. Rev Port Cir Cardiotorac Vasc. 2017;24(3-4):145. PubMed PMID: 29701376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What About Having a Hydropneumothorax Every Month? AU - Lopes,Sara, AU - Maciel,João, AU - Cabral Bastos,Pedro, AU - Pinho,Paulo, PY - 2017/07/18/received PY - 2018/4/28/entrez PY - 2018/4/28/pubmed PY - 2019/5/24/medline SP - 145 EP - 145 JF - Revista portuguesa de cirurgia cardio-toracica e vascular : orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular JO - Rev Port Cir Cardiotorac Vasc VL - 24 IS - 3-4 N2 - INTRODUCTION: Endometriosis is a pathological, benign, inflammatory condition characterized by the presence of endometrial glands and stroma outside the uterine cavity, typically in the pelvis. In rare conditions, this estrogen-dependent disease may be extrapelvic, presenting with a variety of symptoms, including Thoracic Endometriosis. METHODS: A 37 year-old woman presented with her third right hydropneumothorax in three months. Her medical history included infertility, an ovarian mass (in study), biliary diskinesia and protein C deficiency. The CT showed a bleb in the right inferior lobe and a pleural effusion. A detailed clinical history revealed a temporal relationship of the hydropneumothoraxes and her menses. RESULTS: She underwent a videothoracoscopy: there were macroscopic tissue alterations all over the parietal and visceral pleura. We performed a biopsy of one of those spots (of the parietal pleura) and an atypical resection of the apex of the apical segment of the right inferior lobe, where the bleb was. A talc pleurodesis was also performed. The patient was discharged at day 1 and is currently under regular follow-up in ambulatory, with no recurrent pneumothoraxes for two months. The histopathology was compatible with a pleural Endometriosis. CONCLUSION: Thoracic endometriosis is a clinical diagnosis, although the histopathologic confirmation is preferred (but not necessary): it should be suspected in reproductive age women who present with hemothorax, pneumothorax, hemoptysis, chest or scapular pain, lung nodules or diaphragmatic rupture perimenstrually, especially right-sided. Most commonly it presents as catamenial pneumothorax and/or hemothorax. Those with high clinical suspicion and/ or imaging supportive of the diagnosis, should undergo an interventional procedure (thoracoscopy), both for diagnose and management. Primary treatment is chest tube drainage. Prevention of recurrence can be medical (hormonal suppression) or surgical (lung resection, pleurectomy, pleurodesis). SN - 0873-7215 UR - https://www.unboundmedicine.com/medline/citation/29701376/What_About_Having_a_Hydropneumothorax_Every_Month L2 - https://medlineplus.gov/endometriosis.html DB - PRIME DP - Unbound Medicine ER -