Catamenial pneumothorax: a rare manifestation of endometriosis

Abstract

Endometriosis is a common gynecological disease that primarily affects premenopausal women. It is mainly found in the pelvis but may be found at several extrapelvic locations. Thoracic endometriosis is a rare extrapelvic location of endometriosis and the leading cause of catamenial pneumothorax. We describe the case of a 35-year-old woman with a background of pelvic pain presenting to the emergency department with chest pain and dyspnea. The chest X-ray in the emergency department showed a large right-sided pneumothorax. Further imaging studies during patient evaluation revealed extensive fibrotic changes in the pelvis and well-defined solid nodules with high signal on T2 and T1-weighted images on MRI in abdominal and thoracic locations, rendering the diagnosis of a catamenial pneumothorax in a patient with pelvic, abdominal and thoracic endometriosis.

Keywords: Catamenial pneumothorax; Endometriosis; Thoracic endometriosis.

Fig. 1

Chest X-ray obtain at admission to the emergency department shows a large volume right-sided pneumothorax.

Fig. 2

Chest CT (mediastinum W [a], lungs W [b]) shows a round, well-demarcated nodule in the right cardiophrenic angle (arrows).

Fig. 3

A well-demarcated solid nodule is found in the right hepatorenal space in the upper abdominal segments intercepted in the chest CT study (arrows).

Fig. 4

Sagittal T2-weighted MRI (a) demonstrates endometriosis involving the anterior compartment of the pelvis, infiltrating the superior portion of the bladder (arrows). Axial T2-weighted MRI (b) and axial T1-weighted MRI with fat saturation (c) show encasement of the superior portion of the blader (arrows).

Fig. 5

Sagittal T2-weighted MRI (a), axial T2-weighted MRI (b), and T1-weighted MRI with fat saturation (c) show involvement of the posterior compartment of the pelvis with endometriosis in the posterior cul-de-sac with infiltration of the rectal wall.

Fig. 6

Pelvic MRI shows a dilated right fallopian tube (arrows). The distended tube has high signal intensity on T1-weighted fat-suppressed imaging due to the presence of blood products (a). A fluid-fluid level can be seen in T2-weighted imaging (b).

Fig. 7

Pelvic MRI axial T2-weighted (a) MRI shows loculated ascites. The fluid has high signal intensity on T1-weighted fat-suppressed imaging due to the presence of blood products (b).

Fig. 8

Chest MRI shows several millimetric right pleural-based nodules (arrows). The nodules have high signal intensity both on T2 (a) and T1-weighted imaging (b).

Fig. 9

Coronal T2-weighted MRI (a) and T1-weighted MRI (b) show a large diaphragmatic nodule with high signal intensity on both sequences (arrows). On T1-weighted imaging, a high signal pleural-based millimetric nodule is noticed (dashed arrow).

Fig. 10

Axial and coronal T2-weighted imaging (a, b) and T1-weighted imaging (c, d) show a large nodule with high signal intensity on both sequences in the right cardiophrenic angle.

Fig. 11

A well-demarcated solid nodule is found in the right hepatorenal space (arrows) in the upper abdominal segments intercepted in the chest MRI study. The nodule has a high signal both in T2 (a) and T1-weighted imaging (b).