Catamenial pneumothorax

Abstract

Catamenial pneumothorax (CP) is the most common form of thoracic endometriosis syndrome, which also includes catamenial hemothorax, catamenial hemoptysis, catamenial hemopneumothorax and endometriosis lung nodules, as well as some exceptional presentations. Usually onset of lung collapse is less than 72 hours after menstruation. Most commonly occurs in women aged 30-40 years, but has been diagnosed in young girls as early as 10 years of age and post menopausal women (exclusively in women of menstrual age) most with a history of pelvic endometriosis. Diagnosis can be hinted by high recurrence rates of lung collapse in a woman of reproductive age with endometriosis. Moreover; CA-125 is elevated. Video-assisted thoracoscopy or medical thoracoscopy is used for confirmation. In our current work we will present all aspects of CP from diagnosis to treatment.

Keywords: Catamenial pneumothorax (CP); chest tube; endometriosis.

Figure 1

Right-sided catamenial pneumothoraces of various sizes, presence of basal air-fluid level, and absence of mediastinal shift, on posteroanterior chest radiograms (erect position). (A) Small apical pneumothorax; (B) medium-sized apical and basal (subpulmonary) pneumothorax; (C,D) large pneumothoraces with hilar lung collapse (visceral pleural line-red arrows, air-fluid level-blue arrows).

Figure 2

A rare finding revealed on posteroanterior chest radiogram of a patient with catamenial pneumothorax. Magnification of the right hemidiaphragm and the lower lung field projection on the anteroposterior radiogram depicted in Figure 1D. Multinodular appearance of the right hemidiaphragm due to multiple confluent diaphragmatic fenestrations and intrathoracic liver protrusion in a patient with catamenial pneumothorax (diaphragmatic “nodules”-black arrows, visceral pleural line-red arrows, air-fluid level-blue arrow).

Figure 3

A rare finding of diaphragmatic “nodules” in a patient with catamenial pneumothorax, due to intrathoracic liver herniation through multiple confluent diaphragmatic fenestrations, on transverse plane of thoracic contrast computed tomography (supine position), showing the lesions revealed on anteroposterior radiogram depicted in Figures 1D,2. A large right-sided pneumothorax, with a posterior air-fluid level (denoting a small quantity of pleural fluid), and five “nodules” of circular contour and various sizes located and at the central tendon of the right hemidiaphragm (representing intrathoracic liver protrusion through multiple confluent diaphragmatic defects) can be noted.

Figure 4

A rare finding of diaphragmatic “nodules” in a patient with catamenial pneumothorax, due to intrathoracic liver herniation through multiple confluent diaphragmatic fenestrations, on coronal (frontal) planes of thoracic contrast computed tomography (CT), also shown on chest radiograms (Figures 1D,2) and on transverse CT plane (Figure 3). Large, right-sided pneumothorax, multiple “nodules” at the lateral surface and the dome of the right hemidiaphragm can be noted.

Figure 5

(A,B) Characteristic diaphragmatic lesions in a patient with catamenial pneumothorax. Multiple circular or elliptical red spots and holes at the right leaflet of the central tendon, having in their majority a maximal diameter of less than 1 cm.

Figure 6

Very rare intraoperative findings in patient with catamenial pneumothorax. Multiple liver protrusions through multiple confluent diaphragmatic defects of various sizes at the tendinous part of the right hemidiaphragm, resulting in a large multipartitioned central defect (preoperative imaging of the lesion shown in Figures 1D,2-4).