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| {{SI}} | | __NOTOC__ |
| | '''For patient information, click [[Catamenial pneumothorax (patient information)|here]]''' |
| | {{Catamenial pneumothorax}} |
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| | ==[[Catamenial pneumothorax overview|Overview]]== |
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| {{CMG}}
| | ==[[Catamenial pneumothorax historical perspective|Historical Perspective]]== |
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| | ==[[Catamenial pneumothorax classification|Classification]]== |
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| | ==[[Catamenial pneumothorax pathophysiology|Pathophysiology]]== |
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| ==Overview== | | ==[[Catamenial pneumothorax causes|Causes]]== |
| '''Catamenial pneumothorax''' is a condition of [[pneumothorax|collapsed lung]] occurring in conjunction with [[menstrual periods]] (catamenial refers to [[menstruation]]), believed to be caused primarily by [[endometriosis]] of the [[pleura]] (the membrane surrounding the [[lung]]).<ref name=mercksource>[http://www.mercksource.com/pp/us/cns/cns_hl_dorlands.jspzQzpgzEzzSzppdocszSzuszSzcommonzSzdorlandszSzdorlandzSzdmd_p_25zPzhtm#12652312 Definition from mercksource.com (Dorlands Medical Dictionary)]</ref>
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| ==Classification== | | ==[[Catamenial pneumothorax differential diagnosis|Differentiating Catamenial pneumothorax from other Diseases]]== |
| 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.
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| ==Symptoms and signs== | | ==[[Catamenial pneumothorax epidemiology and demographics|Epidemiology and Demographics]]== |
| Onset of lung collapse is less than 72 hours after menstruation. Typically, it occurs in women aged 30-40 years, but 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 [[pelvis|pelvic]] [[endometriosis]].
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| ==Pathophysiology== | | ==[[Catamenial pneumothorax risk factors|Risk Factors]]== |
| [[Endometriosis]] can attach to the lung, forming chocolate-like [[cyst]]s. 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<ref name=AmJMed>Joseph J, Sahn SA. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. ''Am J Med'' 1996; '''100''': 164-70. PMID 8629650</ref> | |
| . How this [[endometrium|endometrial tissue]] reaches the thorax remains enigmatic, although defects in the diaphragm can often be found.<ref name=chest>Alifano M, Roth T, Broet SC, Schussler O, Magdeleinat P, Regnard JF. Catamenial pneumothorax: a prospective study. ''Chest'' 2003; '''124''': 1004-8. PMID 12970030</ref>
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| 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]]).<ref name=book>Glynis D. Wallace. ''Living With Lung And Colon Endometriosis: Catamenial Pneumothorax''. Authorhouse, 2005. ISBN 1-4208-8331-3</ref>
| | ==[[Catamenial pneumothorax natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| [[Diagnosis]] can be hinted by high recurrence rates of lung collapse in a woman of reproductive age with endometriosis. [[CA-125]] is elevated. Nowadays, video-assisted [[thoracoscopy]] is used for confirmation. | | [[Catamenial pneumothorax history and symptoms| History and Symptoms]] | [[Catamenial pneumothorax physical examination | Physical Examination]] | [[Catamenial pneumothorax laboratory findings|Laboratory Findings]] | [[Catamenial pneumothorax chest x ray|Chest X Ray]] | [[Catamenial pneumothorax CT|CT]] | [[Catamenial pneumothorax MRI|MRI]] | [[Catamenial pneumothorax ultrasound|Ultrasound]] | [[Catamenial pneumothorax other imaging findings|Other Imaging Findings]] | [[Catamenial pneumothorax other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| Pneumothorax is a [[medical emergency]] because it comes with severe [[Pain and nociception|pain]] and decreased lung function. A [[chest tube]] should be inserted after clinical assessment. This releases the air and menstrual blood, and the lung can re-expand.
| | [[Catamenial pneumothorax medical therapy|Medical Therapy]] | [[Catamenial pneumothorax surgery|Surgery]] | [[Catamenial pneumothorax primary prevention|Primary Prevention]] | [[Catamenial pneumothorax cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Catamenial pneumothorax future or investigational therapies|Future or Investigational Therapies]] |
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| Surgery, hormonal treatments and combined approaches have all been proposed, with variable results in terms of short and long term outcome.<ref name=Peikert_2005>{{cite journal |author=Peikert T, Gillespie DJ, Cassivi SD |title=Catamenial pneumothorax: case report and review of the literature |journal=Mayo Clinic Proceedings |volume=80 |issue=5 |pages=677-680 |year=2005 |pmid=15887438}}</ref> Surgical removal of the endometrial tissue should be endeavoured during menstruation for optimal visualisation of the cyst.<ref name=asian>Poyraz AS, Kilic D, Hatipoglu A, Demirhan BA. A very rare entity: catamenial pneumothorax. ''Asian Cardiovasc Thorac Ann'' 2005; '''13''':271-3. PMID 16113003</ref> [[Pleurodesis]] may also be helpful. Menstruation and accompanying lung collapse can be suppressed with hormone therapy,<ref name=eMedicine>{{eMedicine|radio|563}}</ref> like with [[Leuprolide|Lupron Depot]], [[danazol]] or [[extended cycle combined oral contraceptive pill]]s.
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| ==Epidemiology== | | ==Case Studies== |
| Some sources claim this entity represents 3-6% of pneumothorax in women.<ref name=eMedicine>{{eMedicine|radio|563}}</ref> In regard of the low [[incidence]] of (primary spontaneous, ''i.e.'' not due to surgical trauma ''etc.'') pneumothorax in women (about 1/100'000/year),<ref name=eMedicine>{{eMedicine|radio|563}}</ref> this is a very rare condition. Hence, many basic textbooks don't mention it, and many [[Physician|doctors]] have never heard of it.<ref name=book>Glynis D. Wallace. ''Living With Lung And Colon Endometriosis: Catamenial Pneumothorax''. Authorhouse, 2005. ISBN 1-4208-8331-3</ref> However, catamenial pneumothorax is probably under-recognised.<ref name=chest>Alifano M, Roth T, Broet SC, Schussler O, Magdeleinat P, Regnard JF. Catamenial pneumothorax: a prospective study. ''Chest'' 2003; '''124''': 1004-8. PMID 12970030</ref>
| | [[Catamenial pneumothorax case study one|Case #1]] |
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| ==References==
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| Review article: Alifano M, Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge. ''Ann Thorac Surg'' 2006; '''81''': 761-9. PMID 16427904
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| <references/>
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