Catamenial pneumothorax

A rare form of pneumothorax associated with menstruation

Catamenial pneumothorax is a rare condition characterized by the occurrence of pneumothorax in conjunction with the menstrual cycle. It is considered a form of thoracic endometriosis syndrome, where endometrial tissue is present in the thoracic cavity.

Pathophysiology

Catamenial pneumothorax is believed to be caused by the presence of endometrial tissue in the thoracic cavity, which can lead to the formation of air leaks during menstruation. The exact mechanism is not fully understood, but several theories have been proposed:

• Diaphragmatic defects: Small holes or fenestrations in the diaphragm may allow air to pass from the abdominal cavity into the pleural space.
• Hormonal influence: The cyclical nature of the condition suggests a hormonal component, possibly related to the effects of estrogen and progesterone.
• Microembolization: Endometrial tissue may travel through the bloodstream and implant in the thoracic cavity.

Clinical Presentation

Patients with catamenial pneumothorax typically present with symptoms of pneumothorax, such as sudden onset of chest pain and dyspnea, occurring within 72 hours of the onset of menstruation. The right side of the chest is more commonly affected.

Diagnosis

The diagnosis of catamenial pneumothorax is based on the correlation of pneumothorax episodes with the menstrual cycle. Imaging studies, such as a chest X-ray or CT scan, can confirm the presence of pneumothorax.

Chest X-ray showing a pneumothorax

Treatment

Treatment options for catamenial pneumothorax include:

• Surgical intervention: Procedures such as video-assisted thoracoscopic surgery (VATS) can be used to repair diaphragmatic defects and remove ectopic endometrial tissue.
• Hormonal therapy: Medications that suppress ovulation, such as gonadotropin-releasing hormone (GnRH) analogs, can be effective in preventing recurrence.
• Pleurodesis: A procedure to obliterate the pleural space and prevent recurrent pneumothorax.

Prognosis

With appropriate treatment, the prognosis for catamenial pneumothorax is generally good. However, recurrence is possible, and long-term management may be necessary.

Related pages

• Pneumothorax
• Endometriosis
• Thoracic endometriosis syndrome

Catamenial pneumothorax Resources
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