Catamenial pneumothorax

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

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.

Catamenial pneumothorax revisited: Clinical approach and systematic review of the literature

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Thoracic endometriosis syndrome: new observations from an analysis of 110 cases

PURPOSE

To determine the demographics, clinical presentations, pathological findings, and the effectiveness of treatment in 110 patients with thoracic endometriosis syndrome (TES).

METHODS

Retrospective analysis based on data published in the English medical literature.

RESULTS

The mean age at presentation of TES was 35 +/- 0.6 years (+/- standard error of the mean) with a range from 15 to 54. The trends of age-specific incidence for pelvic endometriosis and TES were similar. The peak incidence for pelvic endometriosis occurred between 24 and 29 years, whereas the peak incidence for TES was between 30 and 34 years. Pneumothorax was the most common presentation, occurring in 80 of 110 (73%), followed by hemothorax in 15 (14%), hemoptysis in 8 (7%), and lung nodules in 7 (6%). The right hemithorax was involved in more than 90% of all manifestations except for nodules. Hemothorax was more often associated with presence of pleural and pelvic endometriosis compared with other manifestations (P < 0.003, P < 0.02). Compared with hormonal treatment, surgical pleurodesis resulted in low recurrence rate for pneumothorax or hemothorax among patients treated with danazol or oral contraceptives.

CONCLUSIONS

There is a significant association between the presence of pelvic endometriosis and TES, with the latter occurring approximately 5 years later. Pneumothorax is the most common manifestation. The most plausible explanation for pathogenesis involves peritoneal-pleural movement of endometrial tissue through diaphragmatic defects and microembolization through pelvic veins. Diagnosis is established on clinical grounds in most cases. Surgical pleural abrasion is superior to hormonal treatment in the long-term management of pneumothorax. Earlier diagnosis and effective therapy of TES can decrease the morbidity of this disease in women during their reproductive period.

Catamenial pneumothorax

Catamenial or menses related pneumothorax is a rare clinical manifestation of pulmonary endometriosis. We document a case where the clinical history was the key to diagnosis, and evidence of endometriosis elsewhere was scanty. Prolonged medical therapy was not preferred in our patient in view of her age and parity. Surgical pleural ablation was carried out to prevent further episodes of life threatening pneumothoraces. The investigations that may be useful in such a patient are discussed and the clinical profile of our patient is compared with those of the few cases reported in the literature.