Catamenial pneumothorax
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Catamenial pneumothorax is a condition of 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).[1]
Classification
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.
Symptoms and signs
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 pelvic endometriosis.
Pathophysiology
Endometriosis can attach to the lung, 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] . How this endometrial tissue reaches the thorax remains enigmatic, although defects in the diaphragm can often be found.[3]
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).[4]
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.
Treatment
Pneumothorax is a medical emergency because it comes with severe 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.
Surgery, hormonal treatments and combined approaches have all been proposed, with variable results in terms of short and long term outcome.[5] Surgical removal of the endometrial tissue should be endeavoured during menstruation for optimal visualisation of the cyst.[6] Pleurodesis may also be helpful. Menstruation and accompanying lung collapse can be suppressed with hormone therapy,[7] like with Lupron Depot, danazol or extended cycle combined oral contraceptive pills.
Epidemiology
Some sources claim this entity represents 3-6% of pneumothorax in women.[7] 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),[7] this is a very rare condition. Hence, many basic textbooks don't mention it, and many doctors have never heard of it.[4] However, catamenial pneumothorax is probably under-recognised.[3]
References
Review article: Alifano M, Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge. Ann Thorac Surg 2006; 81: 761-9. PMID 16427904
- ↑ Definition from mercksource.com (Dorlands Medical Dictionary)
- ↑ Joseph J, Sahn SA. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med 1996; 100: 164-70. PMID 8629650
- ↑ 3.0 3.1 Alifano M, Roth T, Broet SC, Schussler O, Magdeleinat P, Regnard JF. Catamenial pneumothorax: a prospective study. Chest 2003; 124: 1004-8. PMID 12970030
- ↑ 4.0 4.1 Glynis D. Wallace. Living With Lung And Colon Endometriosis: Catamenial Pneumothorax. Authorhouse, 2005. ISBN 1-4208-8331-3
- ↑ Peikert T, Gillespie DJ, Cassivi SD (2005). "Catamenial pneumothorax: case report and review of the literature". Mayo Clinic Proceedings. 80 (5): 677–680. PMID 15887438.
- ↑ Poyraz AS, Kilic D, Hatipoglu A, Demirhan BA. A very rare entity: catamenial pneumothorax. Asian Cardiovasc Thorac Ann 2005; 13:271-3. PMID 16113003
- ↑ 7.0 7.1 7.2 radio/563 at eMedicine