Presentation
We present a case of catamenial pneumothorax due to bilateral pulmonary endometriosis in a 45-year-old woman. [ncbi.nlm.nih.gov]
Entire Body System
-
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]
Respiratoric
-
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]
Conclusion Catamenial Pneumothorax remains underdiagnosed but should be suspected in reproductive age women who present with cyclical dyspnea during the perimenstrual period. [onlinelibrary.wiley.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]
Patient 1 is 31 years old and presented with chest pain, dyspnea and a right hemothorax. [elsevier.es]
-
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]
Signs Examination may be unremarkable Tachycardia may be the only clinical finding (single most common finding) Keep high index of suspicion COPD patients Tall, thin males Changes on affected side Unilateral absent or decreased breath sounds Hyperresonance [fpnotebook.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
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]
Gastrointestinal
-
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]
Cardiovascular
-
Chest Pain
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]
Eyes
-
Prolapse
RESULTS: In all 3 cases we found no signs of lung defects or bullae, instead, we identified diaphragm defects of different extension, even a liver prolapse in one of the cases. [ncbi.nlm.nih.gov]
She only suffered from mild hypertension, mitral valve prolapse and glaucoma. The patient was on estro-progestinic medication. A right chest drain was placed. The subsequent chest X-ray demonstrated an almost complete expansion of the affected lung. [ghrnet.org]
Urogenital
-
Cervical Mucus Plug
Air supposedly flows into the peritoneum via the fallopian tubes due to the absence of a cervical mucus plug during the menstrual cycle. [3,13-18] Retrograde menstruation (migration theory) The clockwise directionality of peritoneal flow from the right [cureus.com]
In the menstrual period the cervical mucus plug is absent, thus permitting communication between the peritoneal cavity and the outside through the uterine and the fallopian tubes. [ijcasereportsandimages.com]
mucus plug. 4, 6 This latter theory explains the non-endometriosis-related catamenial pneumothorax better. [rc.rcjournal.com]
The air that enters the thorax is hypothesized to originate from the fallopian tubes due to a lack of cervical mucus plug during menstruation, then travels through the peritoneum and past the diaphragm. [biomedgrid.com]
mucus plug, passage of air from the genital tract through congenital or acquired diaphragmatic defects. [scipedia.com]
-
Vaginal Dryness
Use of GnRH analogs is typically limited to 6 to 12 months due to side effects14 of hypoestrogenism, particularly decreased trabecular bone density, vaginal dryness, and hot flashes. [biomedgrid.com]
The treatment is restricted to 6 months, because side effects, mostly loss of trabecular bone density, hot flashes and vaginal dryness. The bone density is usually restored 2 years after treatment cessation [21, 22]. [cardiothoracicsurgery.biomedcentral.com]
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]
X-Ray
-
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]
Treatment
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]
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]
We want to emphasize how the importance of conducting a diagnosis and having a timely management would improve the quality of life of the patient and give a better prognosis of the disease. [clinicsinsurgery.com]
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]
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]
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. [insights.ovid.com]
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]
Pathophysiology
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]
Although the exact pathophysiology of catamenial pneumothorax is still unknown, there are 3 main theories. [rc.rcjournal.com]
Pathophysiology [ edit ] Endometrial tissue attaches within the thoracic cavity, forming chocolate-like cysts. [en.wikipedia.org]
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]