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Catamenial Pneumothorax

Pneumothorax Spontaneous Catamenial


Presentation

  • From 1993 to 2008, ten women presented at our department with CP.[ncbi.nlm.nih.gov]
  • We present a case of catamenial pneumothorax due to bilateral pulmonary endometriosis in a 45-year-old woman.[ncbi.nlm.nih.gov]
  • A case of recurrent bilateral catamenial pneumothorax is presented with pathologic, cytologic, and radiologic documentation.[ncbi.nlm.nih.gov]
  • Extra pelvic endometriosis is rare and its presentation is varied. A case of pulmonary and umbilical endometriosis which presented as catamenial pneumothorax is presented.[ncbi.nlm.nih.gov]
  • A series of four patients with catamenial pneumothorax managed at our institution is presented to highlight the condition to various surgical specialties to whom it may present, and to emphasise the importance of both surgical and hormonal interventions[ncbi.nlm.nih.gov]
Asymptomatic
  • The patient received a long-acting GnRH agonist (Triptorelin-Arvekap-Ipsen) 3.75 mg/month I.M. for nine months and remains asymptomatic with regular periods 12 months after discontinuing the treatment.[ncbi.nlm.nih.gov]
  • One patient was asymptomatic during 11 months of menstrual suppression with hormones but subsequently required surgery where diaphragmatic perforations were found.[ncbi.nlm.nih.gov]
  • Therapy with a gonadotropin-releasing hormone analogue was started and the patient has since been asymptomatic for 6 months. Pathologists should not overlook diaphragmatic stromal endometriosis as a possible cause of pneumothorax.[ncbi.nlm.nih.gov]
  • The patient has remained asymptomatic in 14-month follow-up. This is, to our knowledge, the first lung cancer accompanied by catamenial pneumothorax.[ncbi.nlm.nih.gov]
  • Six months after surgery, the patient remains asymptomatic with no evidence of recurrence of pneumothorax. This case supports recent reports that diaphragmatic defects are often present in patients with catamenial pneumothorax.[ncbi.nlm.nih.gov]
Hyperthermia
  • This paper presents a patient showing both the unusual syndrome of catamenial pneumothorax and a strong family history of malignant hyperthermia. The anaesthetic management is described and discussed.[ncbi.nlm.nih.gov]
Dyspnea
  • Gradually, however, the pain occurred more frequently and became associated with dyspnea and a sensation of a "fluid motion" in her chest.[mayoclinic.pure.elsevier.com]
  • A 45-year-old nonsmoking woman with repeated coughing and dyspnea on effort was admitted to our hospital diagnosed with right-sided pneumothorax on chest X-ray. Chest computed tomography showed neither bullae nor nodules.[ncbi.nlm.nih.gov]
  • She was admitted because of acute dyspnea, and a recurrent right-sided pneumothorax was diagnosed (Panel A).[nejm.org]
  • Patient 1 is 31 years old and presented with chest pain, dyspnea and a right hemothorax.[elsevier.es]
  • A 44-year-old woman with history of endometriosis on ovulatory suppressant therapy and right spontaneous pneumothorax treated with tube thoracostomy 2 months prior, presented with dyspnea and pleuritic chest pain.[amjmed.org]
Hyperresonance
  • Physical examination was remarkable for decreased breath sounds and hyperresonance over the right hemithorax. Her labs were unremarkable. Chest radiography revealed a right pneumothorax ( Figure 1 ).[amjmed.org]
  • Physical findings classically consist of absent tactile fremitus, hyperresonance to percussion, and decreased breath sounds on the affected side.[merckmanuals.com]
  • Rarely, there may be cyanosis (bluish discoloration of the skin due to low oxygen levels), altered level of consciousness, a hyperresonant percussion note on examination of the affected side with reduced expansion and decreased movement, pain in the epigastrium[en.wikipedia.org]
Productive Cough
  • A 40-year-old woman had experienced monthly right thoracic pain and productive cough occurring at the beginning of her menstrual period. X-ray findings indicated a diagnosis of catamenial pneumothorax.[ncbi.nlm.nih.gov]
  • The patient presented with a 3-year history of intermittent productive cough with blood-tinged sputum, chronic anemia, loss of appetite, and general weakness associated with menstruation.[ncbi.nlm.nih.gov]
Pleuritic Pain
  • The patient recalled often having developed the right-sided pleuritic pain of pneumothorax during or shortly after sexual intercourse. She had no symptoms or signs to suggest endometriosis.[ncbi.nlm.nih.gov]
Sputum
  • The patient presented with a 3-year history of intermittent productive cough with blood-tinged sputum, chronic anemia, loss of appetite, and general weakness associated with menstruation.[ncbi.nlm.nih.gov]
Loss of Appetite
  • The patient presented with a 3-year history of intermittent productive cough with blood-tinged sputum, chronic anemia, loss of appetite, and general weakness associated with menstruation.[ncbi.nlm.nih.gov]
Chest Pain
  • A case of Catamenial pneumothorax is presented of a 38-year-old young married woman, admitted to hospital with signs and symptoms including chest pain and shortness of breath that started with her menstrual period.[ncbi.nlm.nih.gov]
  • The diagnosis of catamenial pneumothorax should be suspected whenever a women in the third or fourth decade of life has recurrent right-sided chest pain temporally associated with menstruation.[ncbi.nlm.nih.gov]
  • Menstruation stopped, and the chest pain disappeared. During a 6-month follow-up period, pneumothorax did not recur. A 38-year-old female smoker reported having had intermittent, recurrent right-sided chest pain for several months.[nejm.org]
  • We describe a 37-year-old woman with recurrent episodes of spontaneous right-sided pneumothorax and chest pain that occurred close to her menstrual periods.[ncbi.nlm.nih.gov]

Workup

  • During workup a comprehensive metabolic panel and a complete blood count were normal. An arterial blood gas showed mild acute respiratory alkalosis. An electrocardiogram showed normal sinus rhythm. Troponin levels were within normal limits.[casereports.in]
Pneumoperitoneum
  • Three women with pneumoperitoneum concomitant to CP. Thoracic/abdominal computed tomography scans and chest x-rays. Presence of pneumoperitoneum coexisting with CP.[ncbi.nlm.nih.gov]
  • We report a rare case of CP complicated with multiple diaphragmatic perforations as the only thoracoscopy finding, and also with right-side isolated pneumoperitoneum confirmed by a chest X-ray.[ncbi.nlm.nih.gov]
  • The fourth patient had indirect evidence of diaphragmatic defects proven by a diagnostic pneumoperitoneum.[ncbi.nlm.nih.gov]
  • Pneumoperitoneum with catamenial pneumothorax. AJR Am J Roentgenol 1990;155:29-30. [ PubMed ] Jablonski C, Alifano M, Regnard JF, et al. Pneumoperitoneum associated with catamenial pneumothorax in women with thoracic endometriosis.[jtd.amegroups.com]
  • Kyobu Geka. 2011 May;64(5):430-433 (10) Catamenial pneumothorax associated with multiple diaphragmatic perforations and pneumoperitoneum in a reproductive woman . Baoquan L, Liangjian Z, Qiang W, Hai J, Hezhong C, Zhiyun X.[catamenial-pneumothorax.com]
Pneumothorax on Chest X-Ray
  • A 45-year-old nonsmoking woman with repeated coughing and dyspnea on effort was admitted to our hospital diagnosed with right-sided pneumothorax on chest X-ray. Chest computed tomography showed neither bullae nor nodules.[ncbi.nlm.nih.gov]
  • In some lung diseases, especially emphysema, it is possible for abnormal lung areas such as bullae (large air-filled sacs) to have the same appearance as a pneumothorax on chest X-ray, and it may not be safe to apply any treatment before the distinction[en.wikipedia.org]
Multiple Pulmonary Nodules
  • Tomography imaging may reveal diaphragmatic endometrial implants as hypo-attenuating areas or identify single or multiple pulmonary nodules.[omicsonline.org]

Treatment

  • After surgery nine patients underwent hormonal treatment: three were put on estrogen-progesterone complex treatment and six received gonadotropin-releasing hormone agonist (GnRH agonist).[ncbi.nlm.nih.gov]
  • The fourth patient suffered a postoperative recurrence when hormonal treatment was delayed for 6 weeks, stressing the importance of hormonal treatment in conjunction with surgery.[ncbi.nlm.nih.gov]
  • Unfortunately, conventional therapy, including hormonal treatment and surgical procedures, seems to be associated with a high rate of recurrence; there is no well-established treatment for CPX.[ncbi.nlm.nih.gov]
  • Retrospective review of the treatment of four women operated for CP in a recent 32-months period.[ncbi.nlm.nih.gov]
  • Surgical treatment has been associated with high recurrence rates. We report our experience with a totally videothoracoscopic approach involving diaphragmatic repair, pleurectomy/abrasion, and hormonal treatment in patients with proven CP.[ncbi.nlm.nih.gov]

Prognosis

  • Treatment and prognosis Most catamenial pneumothoraces are small and self-resolving. Partial diaphragmatic resection and/or excision of visceral pleural implants, as well as talc pleurodesis, are sometimes carried out as part of treatment.[radiopaedia.org]
  • Prognosis As I mentioned above recurrence is more common if the surgeon fails to recognise the catamenial pattern and treat the cause of the CM PMX.[mactheknife.org]
  • The prognosis is usually favorable and depends on several factors such as age, time of compression and associated injuries. Contributors : ROJ: patient management, literature review, KVB: literature review, writing manuscript.[casereports.in]
  • Treatment and prognosis Treatment depends on a number of factors: size of the pneumothorax symptoms background lung disease/respiratory reserve Estimating the size of pneumothorax is somewhat controversial with no international consensus.[radiopaedia.org]

Etiology

  • Although it has been known to be associated with thoracic endometriosis, varying clinical course and the lack of consistent intraoperative findings have led to conflicting etiological theories.[ncbi.nlm.nih.gov]
  • It has been associated with thoracic endometriosis, yet varying clinical courses and the lack of consistent intraoperative findings have led to conflicting etiologic theories.[ncbi.nlm.nih.gov]
  • Numerous mechanisms have been postulated in the etiology of catamenial pneumothorax and treatment is still controversial.[ncbi.nlm.nih.gov]
  • The etiology is not completely known, but in most cases it is associated with thoracic endometriosis and/or diaphragmatic fenestrations. We report a case of a 35-year-old woman with three episodes of catamenial pneumothorax.[ncbi.nlm.nih.gov]
  • The etiology and pathogenesis is enigmatic. We describe the case of a 42-year-old woman with right-sided catamenial pneumothorax recurring four times, caused by ectopic endometriosis in the pleural layers which was confirmed histopathologically.[ncbi.nlm.nih.gov]

Epidemiology

  • The condition is now more easily recognized and several studies have been published, with somewhat relevant discrepancies with respect to etiologic, epidemiologic, and management features.[ncbi.nlm.nih.gov]
  • Neurology and Neurosurgery Czech and Slovak Ophthalmology Czech and Slovak Psychiatry Czech Geriatric Review Czech Gynaecology Czech Rheumatology Czech Dental Journal Czech Urology Czech-Slovak Dermatology Czecho-Slovak Pathology Czech-Slovak Pediatrics Epidemiology[prolekare.cz]
  • Epidemiology Some sources claim this entity represents 3-6% of pneumothorax in women. [ 8 ] In regard of the low incidence of primary spontaneous pneumothorax ( i.e. not due to surgical trauma etc. ) in women (about 1/100'000/year), [ 8 ] this is a very[thefullwiki.org]
  • Epidemiology [ edit ] Some sources claim this entity represents 3 to 6% of pneumothorax in women. [8] In regard of the low incidence of primary spontaneous pneumothorax ( i.e. not due to surgical trauma etc. ) in women (about 1/100'000/year), [8] this[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • To elucidate the pathophysiology of catamenial pneumothorax (CP) due to thoracic endometriosis and support the theory of the transdiaphragmatic passage of air from the genital tract through diaphragmatic perforations caused by endometrial implants.[ncbi.nlm.nih.gov]
  • The rarity of catamenial pneumothorax makes understanding of its pathophysiology and verification of etiological mechanisms difficult. To contribute evidence to the knowledge base on the pathogenesis of catamenial pneumothorax.[ncbi.nlm.nih.gov]
  • […] metastases esp. osteosarcoma, pancreas, adrenal, Wilms tumor (e) Connective tissue disorder: scleroderma, rheumatoid disease, Marfan syndrome, EhlersDanlos syndrome (f) Pneumoconiosis: silicosis, berylliosis (g) Vascular disease: pulmonary infarction Pathophysiology[slideshare.net]
  • Pathophysiology [ edit ] Endometrial tissue attaches within the thoracic cavity, forming chocolate-like cysts.[en.wikipedia.org]
  • Although the exact pathophysiology of catamenial pneumothorax is still unknown, there are 3 main theories.[rc.rcjournal.com]

Prevention

  • However, emphasizing secondary prevention, we developed a new method. This powerful new technique for prevention of pneumothorax during menstruation by surgical pleurodesis using absorbable mesh is presented.[ncbi.nlm.nih.gov]
  • Surgical pleural ablation was carried out to prevent further episodes of life threatening pneumothoraces.[ncbi.nlm.nih.gov]
  • A trial of cyclic birth control pills was unsuccessful in preventing recurrent pneumothoraces. Finally, approximately a year ago, laparoscopic tubal ligation was performed. The patient has not had pneumothorax since.[ncbi.nlm.nih.gov]
  • Despite uncertainty as to the etiology of catamenial pneumothorax, diagnosis of the condition is straightforward and modern treatment is successful in preventing recurrence.[ncbi.nlm.nih.gov]
  • Our recent clinical observations put into question the routine hormonal therapy for pneumothorax recurrence prevention, in patients operated for catamenial pneumothorax (CP).[ncbi.nlm.nih.gov]

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