Cataminal pneumothoraces and thoracic endometriosis

Q: 34 years old female with 2 episodes of right-sided spontaneous pneumothoraces in the 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 the management of recurrent cataminal pneumothoraces except?

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


Answer:  E

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

Cataminal pneumothoraces refer to episodes of pneumothorax corresponding to the menses of the patient; otherwise, they should be called noncataminal pneumothoraces.


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.