Spiral Computerized Tomography and Video Thoracoscopy in Catamenial Pneumothorax

doi:10.1016/S0002-9629(15)40717-7

The American Journal of the Medical Sciences

Volume 319, Issue 3, March 2000, Pages 186-188

https://doi.org/10.1016/S0002-9629(15)40717-7 Get rights and content

Abstract

Catamenial pneumothorax is a rare disease that is usually diagnosed on clinical grounds. Delay in diagnosis can lead to considerable morbidity. We describe a case in which spiral CT scan and videothoracoscopy led to early objective diagnosis and management.

References (6)

J. Joseph et al.
Thoracic endometriosis syndrome: new observations from an analysis of 110 cases
Am J Med
(1996)
D.L. Elliot et al.
Catamenial hemoptysis: new methods of diagnosis and therapy
Chest
(1985)
R.L. Barbieri et al.
Elevated serum concentrations of CA-125 in patients with advanced endometriosis
Fertil Steril
(1986)

There are more references available in the full text version of this article.

Cited by (16)

Thoracic Endometriosis: A Review Comparing 480 Patients Based on Catamenial and Noncatamenial Symptoms
2022, Journal of Minimally Invasive Gynecology
Citation Excerpt :
The final exclusion was made of cases in which the patient's symptomatology was not presented clearly or endometriosis was an incidental operative finding. The final exclusion yielded 240 articles and 480 patients for inclusion in this review (Fig. 1) [7–246]. The patients were categorized for assessment into 2 groups depending on whether the presentation of their symptoms was catamenial (n = 419) or noncatamenial (n = 61).
This review aimed to categorize thoracic endometriosis syndrome (TES) according to whether the presenting symptoms were catamenial and to evaluate whether such a categorization enables a better management strategy.
An electronic search was conducted using the PubMed/Medline database.
The following keywords were used in combination with the Boolean operators AND OR: “thoracic endometriosis syndrome,” “thoracic endometriosis,” “diaphragm endometriosis,” and “catamenial pneumothorax.”
The initial search yielded 445 articles. Articles in non-English languages, those whose full texts were unavailable, and those that did not present the symptomatology clearly were further excluded. After these exclusions, the review included 240 articles and 480 patients: 61 patients in the noncatamenial group and 419 patients in the catamenial group. The groups differed significantly in presenting symptoms, surgical treatment techniques, and observed localization of endometriotic loci (p <.05).
This review points out the significant differences between patients with TES with catamenial and noncatamenial symptoms. Such categorization and awareness by clinicians of these differences among patients with TES can be helpful in designing a management strategy. When constructing management guidelines, these differences between patients with catamenial and noncatamenial symptoms should be taken into consideration.
Evaluation of secondary spontaneous pneumothorax with multidetector CT
2013, Clinical Radiology
Citation Excerpt :
The primary clinical feature is pneumothorax that has a temporal relation with menstruation. Seeding of endometrial tissue to the pleural cavity can lead to cyclical pneumothorax, with pleural thickening and haemothorax identified on MDCT (Fig 12).46 Case series of females with pneumothorax have suggested that 0.9–5.6% are due to pleural endometriosis.47,48
The purpose of this article is to review the underlying causes of secondary pneumothoraces as observed on multidetector computed tomography (MDCT). Using examples from our institutional experience, we shall illustrate important diagnostic features to indicate the underlying lung disease. Understanding the varied range of conditions is important for accurate diagnosis and facilitation of patient management.
Catamenial pneumothorax secondary to thoracic endometriosis
2009, Clinica e Investigacion en Ginecologia y Obstetricia
Se presenta el caso de una mujer de 27 años, con 3 gestaciones, una cesárea, menarquia a los 13 años, ciclos regulares con dismenorrea incapacitante en 2 ocasiones por año, una pareja sexual, que refirió dispareunia leve y a la que se trasladó a este hospital desde una población rural de Jalisco. Se encontraba en malas condiciones generales, con disnea intensa, ya que refirió que ésa era la tercera ocasión en que experimentaba este mismo cuadro clínico en los últimos 4 meses. Presentaba neumotórax del 40%, por lo que se le colocó un drenaje cerrado de tórax. Tres días después, la mujer presentó una mejoría considerable respecto a su ingreso: la tomografía pulmonar mostró el área pulmonar sin afectación. Se le realizó cuantificación del marcador tumoral CA 125, que dio como resultado 102 U/ml; el ultrasonido pélvico mostró una imagen anecoica de 4×5 cm en el anexo izquierdo y, a través de la laparotomía pélvica, se encontró una endometriosis leve con lesiones en la pared posterior uterina pero sin lesiones diafragmáticas. Por medio de una toracoscopia, se visualizaron 3 focos endometriósicos: 2 de aproximadamente 1×1 cm, y uno de 1×0,5 cm, que se reportaron histológicamente como tejido endometrial en el parénquima pulmonar.
We report the case of a 27-year-old tertipara, with one caesarean, with menarche at the age of 13 years, regular cycles, disabling dysmenorrhea twice a year, and one sexual partner, who reported mild dyspareunia and was referred to our hospital, which serves a rural population in Jalisco (Mexico). The patient showed poor general health status, with severe dyspnea, and reported that she had experienced the same symptoms twice before in the previous 4 months. The patient showed a pneumothorax size of 40%. A closed chest drainage system was placed, producing substantial improvement in the 3 subsequent days with respect to admission. Pulmonary tomography 3 days later showed no abnormalities. CA125 determination revealed 102 U/ml and pelvic ultrasound showed a positive anechoic, 4×5-cm image in the left annex. Pelvic laparotomy was performed, revealing mild endometriosis with lesions in the posterior uterine wall and no diaphragmatic lesions. Thoracoscopy showed two endometriotic foci of approximately 1×1 cm, and another of 1×0.5 cm. The histological diagnosis was endometrial tissue in the lung parenchyma.
Thoracic endometriosis
2007, Revue des Maladies Respiratoires
Le terme « endométriose thoracique » désigne les manifestations respiratoires liées classiquement à la présence et aux modifications cycliques de tissu endométrial dans l’une des structures du thorax.
L’endométriose thoracique regroupe quatre entités cliniques bien reconnues : pneumothorax, hémothorax, hémoptysie et nodule pulmonaire (respectivement 73 %, 14 %, 7 % et 6 % des cas). Leur point commun est la répétition des symptômes lors des règles chez des femmes habituellement entre 30 et 40 ans, et une atteinte prédominante de l’hémithorax droit. Une endométriose pelvienne est le plus souvent, mais non systématiquement, associée. Le pneumothorax cataménial n’est pas toujours dû à une endométriose thoracique et ses mécanismes restent méconnus. Un traitement chirurgical est justifié par la fréquence des récidives sous traitement médical seul. La vidéo-thoracoscopie est actuellement la technique de choix permettant de visualiser au mieux des anomalies pleuro-diaphragmatiques pathognomoniques présentes dans environ un tiers des cas. Le geste consiste à réparer les fentes diaphragmatiques et à exciser toutes les lésions d’endomètriose visibles et il sera éventuellement complété par une abrasion pleurale. L’association avec une hormonothérapie prolongée est de plus en plus préconisée, en privilégiant le Danazol ou les analogues de la GnRH.
De futures études prospectives devraient permettre de mieux apprécier l’incidence réelle de l’endométriose thoracique et de définir l’approche thérapeutique optimale.
L’endométriose thoracique est une maladie probablement rare mais dont le diagnostic est aisé lorsqu’on sait l’évoquer devant des manifestations cliniques variées. Sa prise en charge est multidisciplinaire et fait intervenir pneumologue, chirurgien thoracique et gynécologue.
Endometriosis is defined as the abnormal presence of endometrial tissue, including endometrial glands and stroma, outside the uterine cavity. The term “thoracic endometriosis” is classically referred to the respiratory manifestations which classically result from the presence and the cyclical changes of endometrial tissue in one of the thoracic structures.
Although thoracic endometriosis is rare, four clinical entities are well-recognized: pneumothorax, hemothorax, haemoptysis and pulmonary nodule, with a respective frequency of 73%, 14%, 7% and 6%. These are characterized by the recurrence of symptoms within the menstruations, in women aged between 30 and 40, and mainly in the right hemi-thorax. Pelvic endometriosis is usually, if not constantly, associated. Catamenial pneumothorax is not always related to thoracic endometriosis and its mechanisms remain unclear. An exploratory and therapeutical surgery is required in most of the cases. Video-assisted-thoracoscopy is the best current approach of catamenial pneumothorax. It may visualize pathognomonic pleuro-diaphragmatic abnormalities, including diaphragmatic fenestrations and/or endometrial implants, in about one third of the patients. Surgical treatment is justified because of the frequent relapses under medical treatment alone. Surgery consists of diaphragmatic repair and excision of all apparent endometrial implants; pleural abrasion may complete the procedure. A combined prolonged hormonal therapy is increasingly recommended, Danazol or GnRH analogs being advantaged.
Further prospective studies are needed to estimate the real incidence of thoracic endometriosis and to devise the best therapeutical option.
Thoracic endometriosis is probably rare but its diagnosis is easy when accurately raised. The approach is multidisciplinary involving a pneumologist, a thoracic surgeon and a gynecologist.
Catamenial pneumothorax revisited: Clinical approach and systematic review of the literature
2004, Journal of Thoracic and Cardiovascular Surgery
Citation Excerpt :
The patient has been symptom free for 13 months. To date, 229 cases of CPT have been reported.1-91 At onset of symptoms, the mean age was 34.2 ± 6.9 years (15-47 years), with age 36.1 ± 6.4 years at time of intervention.
Catamenial pneumothorax is a rare entity of spontaneous, recurring pneumothorax in women. It has been associated with thoracic endometriosis, yet varying clinical courses and the lack of consistent intraoperative findings have led to conflicting etiologic theories.
We discuss etiology, clinical course, and surgical treatment of 3 women with catamenial pneumothorax. In addition, the world literature since the first description is reviewed.
Three women (31, 32, and 39 years old) had recurrent, menses-associated, right-sided spontaneous pneumothoraces. They had undergone video-assisted thoracoscopic surgery previously, with various unsuccessful procedures. Finally, with video-assisted thoracoscopic surgery multiple small perforations in the tendinous part of the right diaphragm with adjacent endometrial implants were detected. After plication of the involved area, 2 patients have been free of recurrence for 22 and 13 months, respectively. Laparoscopic evaluation in 1 woman with a further recurrence revealed asymptomatic pelvic endometriosis. This patient has been free of recurrence since initiation of luteinizing hormone–releasing hormone analog therapy for 17 months. In a review of 229 cases of catamenial pneumothorax in the literature, adequate information was given for 195 patients (85.2%). One hundred fifty-four (79%) were treated surgically, with detailed findings reported for 140 (91%). Thoracic endometriosis was diagnosed in 73 patients (52.1%), and 54 (38.8%) showed diaphragmatic lesions. Pleurodesis, with or without diaphragmatic repair or wedge resection, was performed in 81.7% of the cases.
Catamenial pneumothorax may be suspected in ovulating women with spontaneous pneumothorax, even in the absence of symptoms associated with pelvic endometriosis. During video-assisted thoracoscopic surgery, inspection of the diaphragmatic surface is paramount. Plication of the involved area alone can be successful. In complicated cases, hormonal suppression therapy is a helpful adjunct.
Catamenial pneumothorax and other thoracic manifestations of endometriosis
2004, Clinics in Chest Medicine

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Case ReportsSpiral Computerized Tomography and Video Thoracoscopy in Catamenial Pneumothorax

Abstract

Am J Med

Chest

Fertil Steril

Case Reports
Spiral Computerized Tomography and Video Thoracoscopy in Catamenial Pneumothorax