Catamenial pneumothorax caused by thoracic endometriosis

Abstract

BackgroundThoracic endometriosis syndrome is a rare form of extrapelvic endometriosis characterized by the presence of functioning endometrial tissue in pleura, lung parenchyma, and airways, associated with a high rate of infertility.Case ReportWe have reported a case of successful management and treatment of thoracic endometriosis syndrome that occurred in a 37-year-old female patient. She underwent thoracoscopic resection of the lesion. During follow-up, we revealed the recurrence of a previously surgically treated thoracic endometriosis. She was initially treated with a gonadotropin-releasing hormone agonist; subsequently this was replaced by a prophylactic treatment with Dienogest.ConclusionThe diagnosis of thoracic endometriosis is challenging. The first line of treatment is medical, whereas the surgical treatment is performed secondly. Moreover, surgical treatment can lead to a significant rate of recurrence, often reduced by a coadjutant medical treatment.

Case report: catamenial pneumothorax

“…The mean age at time of diagnosis is 35±7 years old 10 . It is commonly right-sided, however, there has been previous occurrence on the left or bilateral chest 12,14,15,16,17 . The diagnosis of catamenial pneumothorax can be a clinical, radiological, surgical or histological 14,15 .…”

“…It is commonly right-sided, however, there has been previous occurrence on the left or bilateral chest 12,14,15,16,17 . The diagnosis of catamenial pneumothorax can be a clinical, radiological, surgical or histological 14,15 . Most patients present with chest pain and dyspnoea 10,12,16,18 .…”

“…On examination, the patient may be tachpnoeic with reduced oxygen saturation or haemodynamically stable, with a decreased chest expansion and reduced breath sound on the afflicted side 14,19,20 . The radiological workup includes: CXR, CT and MRI scans 15 ( Table 1). In our patient, the CXR only showed pneumothorax.…”

“…In the first instance of spontaneous pneumothorax in clinically stable patients with small catamenial pneumothorax (<2-3cm on CXR), patients should be observed over ≥ 6 hours period, given high flow oxygen to aid resorption of pleural air, have a repeat CXR prior to discharge, as well as an outpatient appointment in 2-4 weeks 25 . Moderate-large catamenial pneumothorax requires needle aspiration or chest tube insertion and longer duration of hospital stay 15 . Catamenial pneumothorax can also be managed with hormonal therapy, surgical intervention or a combination of both 10 .…”

Catamenial pneumothorax after multiple failed in vitro fertilization cycles

“…TE is explained through several plausible mechanisms: migration of endometrial cells (through the fallopian tubes and the diaphragmatic fenestrations caused by the cyclical proliferation and necrosis of the diaphragmatic endometriotic foci), hematogenous microembolization, and lymphatic metastasis 1 . CP is the most common clinical manifestation of TE [8][9][10][11] . Pelvic endometriosis is described in 20-70% of CP patients similar to TE, which is not always confirmed in cases of CP (either macroscopically or histologically) 3 .…”