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YAVUZ H, ÇEVİK ERGÖNÜL A, AKÇAM Tİ, ÇAĞIRICI U. A rare pneumothorax case: catamenial pneumothorax. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1127892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Endometriosis can be defined as the presence of endometrial glands and stroma outside the uterus. Pulmonary involvement of endometriosis can also be seen, and it is most frequently encountered with catamenial pneumothorax clinic. In our report, a 38-year-old woman operated due to recurrent pneumothorax is presented. In this case undergoing lung resection with Video-Assisted Thoracoscopic Surgery for the purpose of surgical treatment, lesions thought to be related to endometriosis were detected in the diaphragmatic pleura. These lesions, which caused pneumothorax, were treated with videothoracoscopic surgery and no recurrence was detected in the 2-year follow-up of the patient. Catamenial pneumothorax should be kept in mind when pneumothorax develops in patients with endometriosis, and in case of recurrence, it should not be forgotten that success in diagnosis and treatment can be achieved with videothoracoscopic surgery.
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Affiliation(s)
- Hasan YAVUZ
- Ege Üniversite Tıp Fakültesi Hastanesi, Göğüs Cerrahisi Anabilim Dalı, İzmir, Türkiye
| | - Ayşegül ÇEVİK ERGÖNÜL
- Ege Üniversite Tıp Fakültesi Hastanesi, Göğüs Cerrahisi Anabilim Dalı, İzmir, Türkiye
| | - Tevfik İlker AKÇAM
- Ege Üniversite Tıp Fakültesi Hastanesi, Göğüs Cerrahisi Anabilim Dalı, İzmir, Türkiye
| | - Ufuk ÇAĞIRICI
- Ege Üniversite Tıp Fakültesi Hastanesi, Göğüs Cerrahisi Anabilim Dalı, İzmir, Türkiye
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2
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Ochi T, Kurihara M, Tsuboshima K, Nonaka Y, Kumasaka T. Dynamics of thoracic endometriosis in the pleural cavity. PLoS One 2022; 17:e0268299. [PMID: 35544515 PMCID: PMC9094567 DOI: 10.1371/journal.pone.0268299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background Thoracic endometriosis-related pneumothorax is a secondary spontaneous pneumothorax caused by thoracic endometriosis. Diaphragmatic endometriosis is well-studied, but visceral and/or parietal pleural lesions are not. Although surgery is an effective treatment, postoperative recurrence rates are unsatisfactory probably due to inadequate understanding of underlying pathophysiology. We aimed to clarify the clinicopathological features of thoracic endometriosis. Methods In total, 160 patients who underwent thoracoscopic surgery from a single institution with histopathologically proven thoracic endometriosis from January 2015 to December 2019 were included. Clinicopathological characteristics and surgical outcomes were assessed retrospectively. Results The cohort median age was 41 (range 22–53) years. Pneumothorax was right-sided in 159 (99.4%) and left-sided in only 1 (0.6%) case. Visceral and parietal pleural lesions were diagnosed in 79 (49.4%) and 71 (44.4%) patients, respectively. In total, 104 visceral pleural lesions and 101 parietal pleural lesions were detected. The S4 region and the dorsal 6th intercostal space contained the largest number of visceral pleural (66 lesions) and parietal pleural lesions (25 lesions), respectively. Histopathological evaluation revealed endometriotic tissues, existing in the outer external elastic layer in all lesions, were localized or invaded deeply. The median follow-up period was 370 (range, 6–1824) days. The Kaplan-Meier method revealed that the 1- and 2-year postoperative recurrence rates were 13.8% and 19.3%, respectively. Conclusions Visceral pleural endometriotic lesions may be disseminated from the visceral pleural surface and infiltrate into the pleura. Intraoperatively, careful observation of the specific sites, such as the visceral pleura of S4 and the parietal pleura of 6th intercostal space, is important to reduce postoperative recurrence.
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Affiliation(s)
- Takahiro Ochi
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Setagaya-ku, Tokyo, Japan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Setagaya-ku, Tokyo, Japan
- * E-mail:
| | - Kenji Tsuboshima
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Setagaya-ku, Tokyo, Japan
| | - Yuto Nonaka
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Setagaya-ku, Tokyo, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
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3
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Svidinskaya EA, Lysenko AV, Brykin GV. [Mystery of endometriosis - catamenial pneumothorax]. Khirurgiia (Mosk) 2022:110-116. [PMID: 35477211 DOI: 10.17116/hirurgia2022041110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review is devoted to clinical picture, main theories of pathogenesis, traditional and innovative methods of diagnosis and surgical treatment of catamenial pneumothorax. Currently, clinicians prefer magnetic resonance imaging and thoracoscopy for diagnosis of this disease. Various researchers are actively searching for laboratory diagnostic methods that can confirm endometrioid nature of pneumothorax. Treatment and prevention of catamenial pneumothorax are a controversial issue depending both clinical picture and preferences of the attending physician. Currently, the majority of authors believe that hormonal therapy combined with diaphragm resection ensures optimal anti-relapse effect in patients with thoracic endometriosis.
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Affiliation(s)
- E A Svidinskaya
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Lysenko
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - G V Brykin
- Sechenov First Moscow State Medical University, Moscow, Russia
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The importance of diaphragmatic surgery, chemical pleurodesis and postoperative hormonal therapy in preventing recurrence in catamenial pneumothorax: a retrospective cohort study. Gan To Kagaku Ryoho 2022; 70:818-824. [PMID: 35286587 DOI: 10.1007/s11748-022-01802-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/03/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Catamenial pneumothorax (CP) is defined as a recurrent, spontaneous pneumothorax occurring within a day before or 72 h after the onset of menstruation. Most first episodes go undiagnosed and treated as primary spontaneous pneumothorax, and only after recurrence is the clinical suspicion of CP raised. No gold-standard management approach exists, especially in terms of managing diaphragmatic involvement. METHODS This study is a single-centre cohort retrospective study of 24 female patients who underwent surgery for pneumothorax due to diaphragmatic endometriosis between January 2008 and December 2016. Two groups were compared: a group that underwent pleurodesis alone (8 patients) and a group that underwent diaphragmatic surgery and pleurodesis (16 patients). RESULTS There were differences in BMI and smoking habits between the two groups. The right diaphragm was involved more often (6vs15, p = 0.190). VATS was the preferred surgical approach and only one conversion occurred in the diaphragmatic surgery group (p = 0.470). Diaphragmatic abnormalities were present in all the patients, brown/violet spots (100%) in the pleurodesis group and perforations (100%) in the diaphragmatic surgery group (p < 0.001). There were no differences in days of chest tube removal and length of stay. The recurrence rate was 100% in the pleurodesis alone group while it was only 12.5% in the diaphragmatic surgery group (< 0.001). CONCLUSIONS In our experience, diaphragmatic surgery and pleurodesis followed by hormonal therapy was an effective approach in preventing recurrence in patients with catamenial pneumothorax and diaphragmatic involvement.
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Topbas Selcuki NF, Yilmaz S, Kaya C, Usta T, Kale A, Oral E. Thoracic Endometriosis: A Review Comparing 480 Patients Based on Catamenial and Noncatamenial Symptoms. J Minim Invasive Gynecol 2021; 29:41-55. [PMID: 34375738 DOI: 10.1016/j.jmig.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/15/2021] [Accepted: 08/01/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE 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. DATA SOURCES An electronic search was conducted using the PubMed/Medline database. METHODS OF STUDY SELECTION The following keywords were used in combination with the Boolean operators AND OR: "thoracic endometriosis syndrome," "thoracic endometriosis," "diaphragm endometriosis," and "catamenial pneumothorax." TABULATION, INTEGRATION, AND RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Nura Fitnat Topbas Selcuki
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Istanbul Sisli Hamidiye Etfal Training and Research Hospital (Dr. Topbas Selcuki)
| | - Salih Yilmaz
- Department of Obstetrics and Gynecology, Acibadem Altunizade Hospital (Dr. Yilmaz)
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University, Acibadem Bakirkoy Hospital (Dr. Kaya)
| | - Taner Usta
- Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University, Acibadem Altunizade Hospital (Dr. Usta).
| | - Ahmet Kale
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Istanbul Kartal Dr. Lutfi Kirdar City Hospital (Dr. Kale)
| | - Engin Oral
- Department of Obstetrics and Gynecology, Bezmialem Vakif University (Dr. Oral), Istanbul, Turkey
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Chittemsetti S, Baikunje N, Hosmane GB, Bhat S. Recurrent pleural effusion secondary to endometriosis: a rare malady. BMJ Case Rep 2021; 14:e240057. [PMID: 33849867 PMCID: PMC8051368 DOI: 10.1136/bcr-2020-240057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/04/2022] Open
Abstract
Thoracic endometriosis is a rare entity, wherein thoracic endometrial tissue deposition occurs. Recurrent pleural effusion is one of its manifestations. Diagnosis and treatment are often challenging, owing to the rarity of the condition and recurrences. We present an interesting case of a young woman of childbearing age who presented with recurrent haemorrhagic pleural effusion. She was referred to our centre after her initial video-assisted thoracoscopic biopsy was inconclusive. She was re-evaluated, and video-assisted thoracoscopic biopsy confirmed thoracic endometriosis. She underwent pleurodesis two times and currently on hormonal treatment, maintaining well.
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Affiliation(s)
| | | | | | - Shubha Bhat
- Pathology, KS Hegde Medical Academy, Mangalore, Karnataka, India
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Mecha E, Makunja R, Maoga JB, Mwaura AN, Riaz MA, Omwandho COA, Meinhold-Heerlein I, Konrad L. The Importance of Stromal Endometriosis in Thoracic Endometriosis. Cells 2021; 10:180. [PMID: 33477657 PMCID: PMC7831500 DOI: 10.3390/cells10010180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 12/11/2022] Open
Abstract
Thoracic endometriosis (TE) is a rare type of endometriosis, where endometrial tissue is found in or around the lungs and is frequent among extra-pelvic endometriosis patients. Catamenial pneumothorax (CP) is the most common form of TE and is characterized by recurrent lung collapses around menstruation. In addition to histology, immunohistochemical evaluation of endometrial implants is used more frequently. In this review, we compared immunohistochemical (CPE) with histological (CPH) characterizations of TE/CP and reevaluated arguments in favor of the implantation theory of Sampson. A summary since the first immunohistochemical description in 1998 until 2019 is provided. The emphasis was on classification of endometrial implants into glands, stroma, and both together. The most remarkable finding is the very high percentage of stromal endometriosis of 52.7% (CPE) compared to 10.2% (CPH). Chest pain, dyspnea, right-sided preference, and diaphragmatic endometrial implants showed the highest percentages in both groups. No significant association was found between the recurrence rate and the various appearances of endometriosis. Sometimes in CPE (6.8%) and CPH (30.6%) no endometrial implants were identified underlining the importance of sensitive detection of endometriosis during and after surgery. We suggest that immunohistochemical evaluation should become mandatory and will improve diagnosis and classification of the disease.
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Affiliation(s)
- Ezekiel Mecha
- Department of Biochemistry, University of Nairobi, Nairobi 00100, Kenya; (E.M.); (R.M.); (C.O.A.O.)
| | - Roselydiah Makunja
- Department of Biochemistry, University of Nairobi, Nairobi 00100, Kenya; (E.M.); (R.M.); (C.O.A.O.)
| | - Jane B. Maoga
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
| | - Agnes N. Mwaura
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
| | - Muhammad A. Riaz
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
| | - Charles O. A. Omwandho
- Department of Biochemistry, University of Nairobi, Nairobi 00100, Kenya; (E.M.); (R.M.); (C.O.A.O.)
- Deputy Vice Chancellor, Kirinyaga University, Kerugoya 10300, Kenya
| | - Ivo Meinhold-Heerlein
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
| | - Lutz Konrad
- Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany; (J.B.M.); (A.N.M.); (M.A.R.); (I.M.-H.)
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8
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Catamenial pneumothorax: multidisciplinary minimally invasive management of a recurrent case. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:107-109. [PMID: 32728375 PMCID: PMC7379218 DOI: 10.5114/kitp.2020.97274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022]
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9
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Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: A review. Reprod Med Biol 2020; 19:323-333. [PMID: 33071634 PMCID: PMC7542014 DOI: 10.1002/rmb2.12340] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background Extra‐pelvic endometriosis is a rare type of endometriosis, which occurs in a distant site from gynecological organs. The diagnosis of extra‐pelvic endometriosis can be extremely challenging and may result in a delay in diagnosis. The main objective of this review was to characterize abdominal wall endometriosis (AWE) and thoracic endometriosis (TE). Methods The authors performed a literature search to provide an overview of AWE and TE, which are the major types of extra‐pelvic endometriosis. Main findings Abdominal wall endometriosis includes scar endometriosis secondary to the surgical wound and spontaneous AWE, most of which occur in the umbilicus or groin. Surgical treatment appeared to be effective for AWE. Case reports indicated that the diagnosis and treatment of catamenial pneumothorax or endometriosis‐related pneumothorax (CP/ERP) are challenging, and a combination of surgery and postoperative hormonal therapy is essential. Further, catamenial hemoptysis (CH) can be adequately managed by hormonal treatment, unlike CP/ERP. Conclusion Evidence‐based approaches to diagnosis and treatment of extra‐pelvic endometriosis remain immature given the low prevalence and limited quality of research available in the literature. To gain a better understanding of extra‐pelvic endometriosis, it would be advisable to develop a registry involving a multidisciplinary collaboration with gynecologists, general surgeons, and thoracic surgeons.
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Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and Gynecology Doai Kinen Hospital Sumida-ku Japan.,Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
| | - Kaori Koga
- Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
| | - Yutaka Osuga
- Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
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Ghisalberti M, Guerrera F, De Vico A, Bertolaccini L, De Palma A, Fiorelli A, Paladini P, Ruffini E, Crisci R, Nosotti M, Mendogni P. Age and Clinical Presentation for Primary Spontaneous Pneumothorax. Heart Lung Circ 2020; 29:1648-1655. [PMID: 32718900 DOI: 10.1016/j.hlc.2020.05.107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/10/2020] [Accepted: 05/12/2020] [Indexed: 02/01/2023]
Abstract
Primary spontaneous pneumothorax (PSP) is a commonly known condition due to the accumulation of air in the pleural space in otherwise healthy people, without apparent underlying lung disease. To date, the exact pathogenesis of PSP is unclear, but it still represents a public health issue. We performed a review of the literature concerning the epidemiology of PSP, examining age of onset and presentation symptoms, in order to assess the possible correlation between these characteristics and its occurrence. Data concerning age, signs, and symptoms were collected. For description purposes, information regarding aetiological and anthropomorphic data was also gathered. In total, 265 papers were evaluated. Regarding age of onset, PSP is a disease that can occur in a broad age group with a double cluster (15-30 and 40-45 yr). Regarding symptoms, pain and dyspnoea (in its various forms) are the most described in PSP. Pain was recorded in 69.25% (range, 9-100%) of the population studied, whereas dyspnoea was present in an average of 54.55% (range, 27-77.1%). Tobacco exposure seems to play an important role in the early onset of PSP. Concerning age at presentation, this review highlights that PSP can occur over a broad age range. The literature appears to be consistent in reporting PSP occurrence mostly below 45 years of age. Asymptomatic PSP is an almost unseen entity. Finally, of pollutants, cigarette smoking should be considered as the most significant exogenous risk factor in the development of PSP.
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Affiliation(s)
| | | | - Andrea De Vico
- Thoracic Surgery Unit, ASST Spedali Civili Brescia, Brescia, Italy
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Angela De Palma
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation (DETO), University Hospital of Bari, Bari, Italy
| | - Alfonso Fiorelli
- Division of Thoracic Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Piero Paladini
- Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy
| | - Enrico Ruffini
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | - Roberto Crisci
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Mendogni
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Sampson CS, White K. Endometriosis: An Unusual Cause of Bilateral Pneumothoraces. Clin Pract Cases Emerg Med 2020; 4:35-37. [PMID: 32064421 PMCID: PMC7012560 DOI: 10.5811/cpcem.2019.11.45061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 11/11/2022] Open
Abstract
A 27-year-old female presented to the emergency department with sudden onset shortness of breath. A diagnosis of bilateral catamenial pneumothoraces was made following chest radiograph. Catamenial pneumothorax is a recurrent spontaneous pneumothorax that occurs in 90% of affected women 24–48 hours after the onset of their menstruation; 30–50% of cases have associated pelvic endometriosis. Symptoms can be as simple as chest pain or as severe as the presentation of this patient who was initially found to be in significant respiratory distress.
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Affiliation(s)
- Christopher S Sampson
- University of Missouri-Columbia, Department of Emergency Medicine, Columbia, Missouri
| | - Kathleen White
- University of Missouri-Columbia, Department of Surgery, Columbia, Missouri
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12
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Extrapelvic Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2020; 27:373-389. [DOI: 10.1016/j.jmig.2019.10.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/23/2019] [Accepted: 10/06/2019] [Indexed: 02/08/2023]
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13
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Thoracic endometriosis-related non-catamenial pneumothorax with peculiar histological findings. Gen Thorac Cardiovasc Surg 2019; 68:1040-1042. [DOI: 10.1007/s11748-019-01184-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/28/2019] [Indexed: 11/25/2022]
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Hiyama N, Sasabuchi Y, Jo T, Hirata T, Osuga Y, Nakajima J, Yasunaga H. The three peaks in age distribution of females with pneumothorax: a nationwide database study in Japan. Eur J Cardiothorac Surg 2019; 54:572-578. [PMID: 29596692 DOI: 10.1093/ejcts/ezy081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/01/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Women are the minority among patients with spontaneous pneumothorax, but catamenial pneumothorax (CP) is unique to them. We aimed to clarify the clinical characteristics of female patients with spontaneous pneumothorax using a nationwide database. METHODS Medical records from the Japanese Diagnosis Procedure Combination database for inpatients with pneumothorax between July 2010 and March 2016 were retrospectively reviewed. Age, underlying diseases, body mass index, smoking status, laterality, number of hospitalizations and treatments were studied. RESULTS We identified 157 087 patients with pneumothorax, including 27 716 (17.6%) women and 129 371 (82.4%) men. The age distribution of female patients with pneumothorax had 3 peaks: 18 years, around 40 years and 80 years; male patients had 2 peaks: 18 years and 79 years. We identified 873 patients with CP; this number was not sufficient to account for the female-specific peak around 40 years. The characteristics of female patients of reproductive age were significantly different between those with and without CP. The patients with CP were older (average age: 37.9 ± 7.7 years vs 31.3 ± 11.5 years, P < 0.001), were right side dominant (right: 64.9%, left: 6.5%), had more hospitalizations (average number of hospitalizations: 1.6 ± 0.9 vs 1.3 ± 0.6, P < 0.001) and had more frequently undergone surgery (57.1% vs 37.3%, P < 0.001). CONCLUSIONS The age distribution of women with pneumothorax had 3 distinct peaks while that of men had 2. CP has different characteristics from other types of pneumothorax, thus requiring different treatment strategies for women of reproductive age.
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Affiliation(s)
- Noriko Hiyama
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | | | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynecology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Shrestha B, Shrestha S, Peters P, Ura M, Windsor M, Naidoo R. Catamenial Pneumothorax, a Commonly Misdiagnosed Thoracic Condition: Multicentre Experience and Audit of a Small Case Series With Review of the Literature. Heart Lung Circ 2019; 28:850-857. [PMID: 30853525 DOI: 10.1016/j.hlc.2019.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/13/2019] [Accepted: 01/19/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Catamenial pneumothorax (CP) is an unusual condition affecting premenopausal women and commonly misdiagnosed as simple pneumothorax. It is characterised by its recurrence between the day before and within 72 hours after the onset of menstruation. It has been associated with thoracic endometriosis but the aetiology is not well understood and there is no unified agreement for its optimal management. The aim of this study is to determine the incidence of CP in surgical patients and the results of their treatment. METHODS Females between the ages of 30 to 50 years with a diagnosis of pneumothorax, admitted for surgery over a 10-year period in four different hospitals were retrospectively reviewed for evidence of CP. An audit of surgical and medical management of the patients with CP and their short to midterm outcomes was performed in addition to a systemic review of the literature on CP. RESULT A total of 120 premenopausal female patients with a diagnosis of pneumothorax were admitted for Video Assisted Thoracoscopic (VAT) surgery and five women (4.1%) with a mean age of 42.6 years were diagnosed to have CP through surgical and histological findings. The first case was diagnosed 5 years ago and the last three within recent 12 months after the changes in surgical practices of inspecting diaphragmatic surface in suspected cases of CP. Four patients underwent diaphragmatic plication and one patient had a pleural biopsy. All patients underwent talc pleurodesis and hormone therapy in the postoperative period. Short to midterm (mean follow-up period of 25.2 months) results of the patients with CP were encouraging. CONCLUSIONS It is possible that many of the cohort of premenopausal female patients presenting with recurrent pneumothorax are misdiagnosed as spontaneous pneumothorax (SP) because routine inspection of the diaphragmatic surface is not often performed. A thorough menstrual history and its temporal relation to pneumothorax onset should be assessed on every woman presenting with recurrent pneumothorax and intraoperative exploration of diaphragmatic surface should be performed in the patients with high suspicion of CP as the patients diagnosed with CP have a good outcome with surgery and hormone therapy.
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Affiliation(s)
- Bishwo Shrestha
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia.
| | | | - Paul Peters
- Department of Cardiothoracic Surgery, Greenslopes Private Hospital, Department of Cardiothoracic Surgery, Mater Private Hospital, Brisbane, Qld, Australia
| | - Masashi Ura
- Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Morgan Windsor
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Rishendran Naidoo
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia
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16
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Histological and Immunohistochemical Characterization of a Case of Endometriosis in a Guinea Pig (Cavia tschudii). Case Rep Vet Med 2018; 2017:4594510. [PMID: 29955430 PMCID: PMC6005282 DOI: 10.1155/2017/4594510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/12/2017] [Indexed: 11/18/2022] Open
Abstract
Endometriosis is a chronic gynecological disease characterized by the ectopic proliferation of endometrial tissue outside of the uterine cavity. The pathogenesis of this disease is still obscure, and Sampson's theory of retrograde menstruation is still the most widely accepted explanation. Endometriosis in animals has been so far described not only in baboons and a rhesus macaque but also in dogs and horses that are nonmenstruating animals. In this article, we report the histological and immunohistochemical characterization of the first case of ovarian cystic endometriosis and adenomyosis in a guinea pig. The case presented supports the hypothesis that endometriosis is a disease not at all related to the phenomenon of retrograde menstruation but is a consequence of some alterations in the morphogenesis of the female genital system and therefore it could be found in any mammal. We suggest considering endometriosis among the other pathological phenotypes in animals displaying ovarian and uterine alterations and having a history of difficulties in conceiving.
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17
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Junejo SZ, Singh Lubana S, Shina SS, Tuli SS. A Case of Thoracic Endometriosis Syndrome Presenting with Recurrent Catamenial Pneumothorax. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:573-576. [PMID: 29769481 PMCID: PMC5985740 DOI: 10.12659/ajcr.907964] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patient: Female, 30 Final Diagnosis: Thoracic endometriosis syndrome Symptoms: Abdominal pain Medication: — Clinical Procedure: Videothoracoscopic pleurodesis Specialty: Pulmonology
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Affiliation(s)
- Shoaib Z Junejo
- Department of Medicine, Icahn School of Medicine at Mount Sinai/ NYC Health + Hospital/Queens, New York, NY, USA
| | - Sandeep Singh Lubana
- Department of Medicine, Icahn School of Medicine at Mount Sinai/ NYC Health + Hospital/Queens, New York, NY, USA
| | - Sukhdip Singh Shina
- Department of Medicine, Icahn School of Medicine at Mount Sinai/ NYC Health + Hospital/Queens, New York, NY, USA
| | - Sandeep Singh Tuli
- Department of Radiology, Icahn School of Medicine at Mount Sinai/ NYC Health + Hospital/Queens, New York, NY, USA
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18
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Ebana H, Mizobuchi T, Kurihara M, Kobayashi E, Haga T, Okamoto S, Takahashi K, Seyama K. Novel clinical scoring system to identify patients with pneumothorax with suspicion for Birt-Hogg-Dubé syndrome. Respirology 2017; 23:414-418. [PMID: 28960698 DOI: 10.1111/resp.13191] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/09/2017] [Accepted: 08/13/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Birt-Hogg-Dubé syndrome (BHDS) is a rare hereditary disease that presents with multiple lung cysts and pneumothorax (PTX). Although some reports propose that findings from chest computed tomography enable one to distinguish BHDS from primary spontaneous pneumothorax (PSP), it is still unclear whether clinical features are useful for identifying patients with suspicion of BHDS from those with PTX. METHODS We retrospectively reviewed the medical records of patients with PTX who underwent video-assisted thoracoscopic surgery at Nissan Tamagawa Hospital from January 2012 to December 2015. RESULTS We identified a total of 1141 patients with PTX, including 54 with BHDS and 517 with PSP. Among them, logistic regression analysis segregated five features that were significantly associated with BHDS: familial history of PTX, past history of bilateral PTX, age at the first episode of PTX (≥25 years old (y.o.)), body mass index (≥18.5) and gender (female). We assigned scores of 3, 3, 2, 2 and 1 to the five features, respectively, to establish a system with a calculated score from 0 to 11. The cut-off value of a calculated score ≥ 4 yielded the highest sensitivity of 93% and specificity of 86%. Receiver operating characteristic (ROC) analysis showed the area under the curve reflecting an accuracy of this diagnostic test as 0.953. CONCLUSION BHDS has several clinical features distinct from PSP. Our scoring system consists of only five clinical variables that are easily evaluated and efficiently separate BHDS patients from those who have PTX without relying on an imaging study. Further prospective study is needed to confirm our findings.
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Affiliation(s)
- Hiroki Ebana
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.,Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Teruaki Mizobuchi
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Etsuko Kobayashi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Takahiro Haga
- The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Shoichi Okamoto
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Kazuhisa Takahashi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Kuniaki Seyama
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
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19
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Lua LL, Tran K, Desai J. Refractory thoracic endometriosis syndrome with bilateral hemothorax. J Obstet Gynaecol Res 2017; 43:1227-1231. [PMID: 28503772 DOI: 10.1111/jog.13331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/06/2017] [Accepted: 02/12/2017] [Indexed: 11/28/2022]
Abstract
Thoracic endometriosis syndrome (TES) is a rare disorder presenting with catamenial pneumothorax, hemothorax, hemoptysis or pulmonary nodules. Bilateral involvement is uncommon, and only a very few cases have been reported in the literature. We report a case of bilateral catamenial hemothorax in a patient with recurrent thoracic endometriosis. Despite multiple surgical interventions, the patient continued to develop hemopneumothorax coinciding with menses. Remission was finally achieved with the addition of gonadotropin-releasing hormone agonist, highlighting the effectiveness of postoperative adjuvant hormone therapy and supporting a combined surgical and medical approach in the treatment of TES in patients who desire future fertility.
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Affiliation(s)
- Lannah L Lua
- Department of Obstetrics and Gynecology, University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - Kevin Tran
- Department of Obstetrics and Gynecology, University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - Jyoti Desai
- Department of Obstetrics and Gynecology, University of Nevada School of Medicine, Las Vegas, Nevada, USA
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20
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Fukuoka M, Kurihara M, Haga T, Ebana H, Kataoka H, Mizobuchi T, Tatsumi K. Clinical characteristics of catamenial and non-catamenial thoracic endometriosis-related pneumothorax. Respirology 2015; 20:1272-6. [DOI: 10.1111/resp.12610] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/20/2015] [Accepted: 06/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Mizuki Fukuoka
- Pneumothorax Research Center and Division of Thoracic Surgery; Nissan Tamagawa Hospital; Tokyo Japan
- Department of Respirology; Graduate School of Medicine; Chiba University; Chuo-ku Chiba Japan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic Surgery; Nissan Tamagawa Hospital; Tokyo Japan
| | - Takahiro Haga
- Pneumothorax Research Center and Division of Thoracic Surgery; Nissan Tamagawa Hospital; Tokyo Japan
- Department of Respirology; Graduate School of Medicine; Chiba University; Chuo-ku Chiba Japan
| | - Hiroki Ebana
- Pneumothorax Research Center and Division of Thoracic Surgery; Nissan Tamagawa Hospital; Tokyo Japan
| | - Hideyuki Kataoka
- Pneumothorax Research Center and Division of Thoracic Surgery; Nissan Tamagawa Hospital; Tokyo Japan
| | - Teruaki Mizobuchi
- Pneumothorax Research Center and Division of Thoracic Surgery; Nissan Tamagawa Hospital; Tokyo Japan
| | - Koichiro Tatsumi
- Department of Respirology; Graduate School of Medicine; Chiba University; Chuo-ku Chiba Japan
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21
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Clinical features of thoracic endometriosis: A single center analysis. Obstet Gynecol Sci 2015; 58:223-31. [PMID: 26023672 PMCID: PMC4444519 DOI: 10.5468/ogs.2015.58.3.223] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 12/01/2014] [Accepted: 12/10/2014] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To analyze the diagnostic profiles and treatment outcomes of patients with thoracic endometriosis at a university hospital. METHODS A retrospective review of medical records was performed for patients diagnosed with thoracic endometriosis at Gangnam Severance Hospital, Yonsei University College of Medicine, between January 2007 and January 2014. RESULTS Fifteen patients (median age, 35 years; range, 23-48 years) were evaluated. Patients presented with catamenial hemoptysis (n=8), or catamenial pneumothorax (n=7). Patients with catamenial pneumothorax were significantly older than those presenting with hemoptysis (P=0.0002). Only 3 patients (20%) had coexisting pelvic endometriosis. All patients underwent chest computed tomography; lesions were shown to predominantly affect the right lung (right lung, n=13, 86.7%; left lung, n=2, 13.3%), and were mainly distributed on the right upper lobe (n=9, 60%). Ten patients underwent video-assisted thoracoscopic surgery, and 1 patient underwent a thoracotomy. Intraoperatively, endometriosis-specific findings were observed in 8/11 patients (72.7%); a further 5/11 patients (45.4%) had histologically detectable endometriosis. Over the follow-up period (mean, 18.4 months; range, 2-65 months) 5/15 patients (33%) had clinical signs of recurrence. Recurrence was not detected in any of the 5 catamenial pneumothorax patients that received adjuvant hormonal therapy after surgery. CONCLUSION The diagnosis and management of thoracic endometriosis requires a multidisciplinary approach, based upon skillful differential diagnosis, and involving careful gynecologic evaluation and assessment of the cyclicity of pulmonary symptoms. Imaging findings are non-specific, though there may be laterality towards the right lung. Since symptom recurrence is more common in those with presenting with pneumothorax, post-operative adjuvant medical therapy is recommended.
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22
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Hirata T, Nakazawa A, Fukuda S, Hirota Y, Izumi G, Takamura M, Harada M, Koga K, Wada-Hiraike O, Fujii T, Osuga Y. Four Cases of Postoperative Pneumothorax Among 2814 Consecutive Laparoscopic Gynecologic Surgeries: A Possible Correlation Between Postoperative Pneumothorax and Endometriosis. J Minim Invasive Gynecol 2015; 22:980-4. [PMID: 25936271 DOI: 10.1016/j.jmig.2015.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVES To evaluate the frequency of pneumothorax after laparoscopic surgery and to identify possible correlations to endometriosis. DESIGN Retrospective review. SETTING Tokyo University Hospital between 2006 and 2013. PATIENTS Four patients among a total of 2814 patients with a postoperative pneumothorax. INTERVENTION Laparoscopic surgery for gynecologic benign disease. The main outcome was the clinical frequency and characteristics of the patients with postoperative pneumothorax. MEASUREMENTS AND MAIN RESULTS We observed 4 (0.14%) cases of postoperative pneumothorax after laparoscopic surgery, all of whom were diagnosed with endometriomas and developed a right-sided pneumothorax. The incidence of postoperative pneumothorax in 1097 patients with endometriomas was 0.36%, which was significantly higher than those without endometriomas. CONCLUSION The presence of endometrioma should be considered a risk factor for postoperative pneumothorax in gynecologic laparoscopic surgery.
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Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
| | - Akari Nakazawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinya Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Gentaro Izumi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Masashi Takamura
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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