Catamenial Pneumothorax

Q; What is Catamenial pneumothorax?

 

Answer: Catamenial pneumothorax is a rare condition defined as recurrent spontaneous pneumothorax occurring within 72 hours before or after the onset of menstruation. 

The etiology of this syndrome is unknown, although many theories have been proposed to explain it. Historically, it has been attributed to intrathoracic endometriosis. Diaphragmatic fenestrations that freely communicate with the peritoneal cavity are often present in patients with catamenial pneumothorax. During uterus lining shedding during menstruation, air passes into the pleural space through these holes. If blood from endometriosis enters the pleural cavity, it may be accompanied by hemothorax. 

 This condition occurs predominantly on the right side., and generally occurs in women in their thirties and forties.  The mean age at presentation varies between 32 and 37 years. The most common symptoms are chest pain and dyspnoea. The disease is believed to be rare, with a prevalence of 1% to 5% among menstruating women with spontaneous pneumothorax.

 

Acute treatment includes pneuma (air) drainage, chest tube, pleurodesis in recurrent cases, and surgical closure of diaphragmatic fenestrations if required.

 

A referral should be made to a GYN service for hormonal and related management of endometriosis.

#pulmonary

#ob-gyn

References: 

1. Gil Y, Tulandi T. Diagnosis and Treatment of Catamenial Pneumothorax: A Systematic Review. J Minim Invasive Gynecol. 2020 Jan;27(1):48-53. doi: 10.1016/j.jmig.2019.08.005. Epub 2019 Aug 8. PMID: 31401265.

2. Marjański T, Sowa K, Czapla A, Rzyman W. Catamenial pneumothorax - a review of the literature. Kardiochir Torakochirurgia Pol. 2016 Jun;13(2):117-21. doi: 10.5114/kitp.2016.61044. Epub 2016 Jun 30. PMID: 27516783; PMCID: PMC4971265.

3. Visouli AN, Zarogoulidis K, Kougioumtzi I, Huang H, Li Q, Dryllis G, Kioumis I, Pitsiou G, Machairiotis N, Katsikogiannis N, Papaiwannou A, Lampaki S, Zaric B, Branislav P, Porpodis K, Zarogoulidis P. Catamenial pneumothorax. J Thorac Dis. 2014 Oct;6(Suppl 4):S448-60. doi: 10.3978/j.issn.2072-1439.2014.08.49. PMID: 25337402; PMCID: PMC4203986.