Catamenial pneumothorax

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Catamenial pneumothorax
Pneumothorax CXR.jpg
Pneumothorax shown on a chest x-ray. Air fills the space between the collapsed left lung and the chest wall.
SpecialtyPulmonology

Catamenial pneumothorax is a condition of air leaking into the pleural space (pneumothorax) occurring in conjunction with menstrual periods (catamenial refers to menstruation), and or during ovulation, believed to be caused primarily by endometriosis of the pleura (the membrane surrounding the lung or diaphragm).[1]

Signs and symptoms[edit]

Onset of lung collapse is less than 72 hours after menstruation. Typically, it occurs in women aged 30 to 40 years, but it has been diagnosed in young girls as early as 10 years of age and post menopausal women (exclusively in women of menstrual age), most with a history of pelvic endometriosis.[citation needed]

Pathophysiology[edit]

Endometrial tissue attaches within the thoracic cavity, forming chocolate-like cysts. Generally the parietal pleura is involved, but the lung itself, the visceral layer, the diaphragm, and more rarely the tracheobronchial tree may also be afflicted.[2] The mechanism through which endometrial tissue reaches the thorax remains unclear. Defects in the diaphragm, which are found often in affected individuals, could provide an entry path,[3] as could microembolization through pelvic veins.[4]

The cysts can release blood; the endometrial cyst "menstruates" in the lung. Air can move in by an unknown mechanism. The blood and air cause the lung to collapse (i.e. catamenial hemopneumothorax).[5]

Diagnosis[edit]

Diagnosis can be hinted by high recurrence rates of lung collapse in a woman of reproductive age with endometriosis. CA-125 is elevated. Video-assisted thoracoscopy is used for confirmation.[citation needed]

Classification[edit]

Catamenial pneumothorax is the most common form of thoracic endometriosis syndrome, which also includes catamenial hemothorax, catamenial hemoptysis, catamenial hemopneumothorax and endometriosis lung nodules, as well as some exceptional presentations.[6]

Treatment[edit]

Pneumothorax can be a medical emergency, as it can become associated with decreased lung function, and if progressed to tension pneumothorax, potentially fatal. In many cases, catamenial pneumothorax will resolve spontaneously and not require immediate intervention. In more severe cases, a chest tube may be required to release air and/or blood and to allow the lung to re-expand.[citation needed]

Surgery, hormonal treatments and combined approaches have all been proposed, with variable results in terms of short and long term outcome.[4] Surgical removal of the endometrial tissue should be endeavoured during menstruation for optimal visualisation of the cyst.[7] Pleurodesis may also be helpful. Menstruation and accompanying lung collapse can be suppressed with hormone therapy,[8] like with Lupron Depot, danazol or extended cycle combined oral contraceptive pills, or GnRH antagonist medications.

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 is a very rare condition. Hence, many basic textbooks do not mention it, and many doctors have never heard of it. Therefore, catamenial pneumothorax is probably under-recognized.[3]

References[edit]

  1. ^ "Definition from mercksource.com (Dorlands Medical Dictionary)". Archived from the original on 2006-07-02. Retrieved 2006-07-01.
  2. ^ Joseph J, Sahn SA (1996). "Thoracic endometriosis syndrome: new observations from an analysis of 110 cases". Am J Med. 100 (2): 164–70. doi:10.1016/s0002-9343(97)89454-5. PMID 8629650.
  3. ^ a b Alifano M, Roth T, Broët SC, Schussler O, Magdeleinat P, Regnard JF (September 2003). "Catamenial pneumothorax: a prospective study". Chest. 124 (3): 1004–8. doi:10.1378/chest.124.3.1004. PMID 12970030.
  4. ^ a b Peikert T, Gillespie DJ, Cassivi SD (May 2005). "Catamenial pneumothorax". Mayo Clinic Proceedings. 80 (5): 677–80. doi:10.4065/80.5.677. PMID 15887438.
  5. ^ ^ a b Glynis D. Wallace. Living With Lung And Colon Endometriosis: Catamenial Pneumothorax. Authorhouse, 2005. ISBN 1-4208-8331-3
  6. ^ Bricelj K; et al. (2017). "A systematic review". Wien Klin Wochenschr. 129 (19–20): 717–726. doi:10.1007/s00508-017-1237-4. PMID 28762057. S2CID 12760621.
  7. ^ Poyraz AS, Kilic D, Hatipoglu A, Demirhan BA (September 2005). "A very rare entity: catamenial pneumothorax". Asian Cardiovascular & Thoracic Annals. 13 (3): 271–3. doi:10.1177/021849230501300317. PMID 16113003. S2CID 46199907.
  8. ^ a b c radio/563 at eMedicine

External links[edit]

Classification