Cataminal pneumothoraces and thoracic endometriosis

Q: 34 year old female with 2 episodes of right sided spontaneous pneumothoraces in last 2 years presented again with right sided chest pain. This time a component of hemothorax is also noted on radiological workup. Diagnosis of cataminal pneumothoraces and thoracic endometriosis is made.  All of the following are parts of management of recurrent cataminal  pneumothoraces except?

A) chest tube insertion
B)  blebectomy 
C)  pleurodesis
D) hormonal suppression
E) pneumonectomy


Answer:  E

Thorax is the most frequent site of extra-pelvic endometriosis. Gold standard diagnosis is histological confirmation. Without histological diagnosis, it should be referred as 'probable thoracic endometriosis'. Patients with frequent symptomatic presentation requires further surgical intervention with blebectomy, pleurodesis and hormonal suppression. Pneumonectomy is not required but in resistant and in debilitating cases pleurectomy or hysterectomy with bilateral salpingo-oophorectomy (BSO) may be needed.

Cataminal pneumothorces refers to episodes of pneumothorax corresponding to menses of the patient, otherwise should be called noncataminal pneumothraces.


References: 

1. Alifano M, Jablonski C, Kadiri H, et al. Catamenial and noncatamenial, endometriosis-related or nonendometriosis-related pneumothorax referred for surgery. Am J Respir Crit Care Med 2007; 176:1048.

2. Legras A, Mansuet-Lupo A, Rousset-Jablonski C, et al. Pneumothorax in women of child-bearing age: an update classification based on clinical and pathologic findings. Chest 2014; 145:354.

3. Bagan P, Le Pimpec Barthes F, Assouad J, et al. Catamenial pneumothorax: retrospective study of surgical treatment. Ann Thorac Surg 2003; 75:378.