Case report
Catamenial Pneumothorax With Bullae

https://doi.org/10.1016/j.athoracsur.2014.05.056Get rights and content

The physiologic mechanisms and diagnostic approach of catamenial pneumothorax remain controversial. We report 3 patients with catamenial pneumothorax with bullae. Endometrial cells in these patients were located around the bullae, suggesting a possible new mechanism for catamenial pneumothorax in which cyclic endometrial shedding in the lung causes destruction of the lining of alveolar epithelial cells and forms bullae. Because intrathoracic endometriosis is considered an underrecognized cause of secondary spontaneous pneumothorax, we performed careful histologic examination for definitive diagnosis of thoracic endometriosis.

Section snippets

Patient 1

A 24-year-old woman presented during her menses with right-sided chest pain and dyspnea of a few hours’ duration. Chest roentgenograms showed a collapsed right lung, and chest computed tomography (CT) revealed a bulla on the right upper lobe of the lung.

Video-assisted thoracoscopic surgery (VATS) was performed to resect the bulla. Histopathologic examination with hematoxylin and eosin (HE) staining (Fig 1A) revealed collapsed small bullae located next to the main bulla, and no overt endometrial

Comment

The underlying physiologic mechanism of catamenial pneumothorax remains obscure. Korom and colleagues [2] reported that in 73 patients with catamenial pneumothorax, who underwent intraoperative exploration, 38.8% had diaphragmatic lesions, such as diaphragmatic endometriosis or perforation, 29.6% had endometriosis of the visceral pleura, 23.1% had bullae/blebs, and 8.5% had no lesions.

Along with these intrathoracic findings, four mechanisms of catamenial pneumothorax have been proposed in the

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Cited by (8)

  • Thoracic Endometriosis: A Review Comparing 480 Patients Based on Catamenial and Noncatamenial Symptoms

    2022, Journal of Minimally Invasive Gynecology
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    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).

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