Catamenial Pneumothorax in a Patient with Endometriosis: A Case Report

Abstract

Pelvic pain is a common presentation to the emergency department (ED). For female patients, endometriosis can be difficult to diagnose and can have life-threatening complications if missed. In this case report, we present a case of a patient initially presenting to the ED with a few days of crampy lower abdominal pain. After initial imaging, she was found to have a large pelvic hematoma with concern for active extravasation and a large hemothorax. After further evaluation, she was suspected of having endometriosis leading to thoracic endometriosis and a catamenial pneumothorax. Although endometriosis is not typically an emergent diagnosis, the complications of significant endometrial tissue spread can cause lifethreatening impacts. Clinicians should consider complications of endometriosis in females of menstruating age.

Catamenial pneumothorax: a rare condition

“…A 38-year-old nulliparous who had an ovarian cyst as a teenager and right pneumothorax at age 35 that was managed by wedge resection, pleurodesis, and diaphragm plication presented intense lower abdominal pain beginning a soon after the menstrual period 9 . Imaging studies revealed a pelvic hematoma in the right adnexal area and large hyperdense right pleural effusion, suggesting passage of blood by diaphragmatic defect 9 .…”

“…A 38-year-old nulliparous who had an ovarian cyst as a teenager and right pneumothorax at age 35 that was managed by wedge resection, pleurodesis, and diaphragm plication presented intense lower abdominal pain beginning a soon after the menstrual period 9 . Imaging studies revealed a pelvic hematoma in the right adnexal area and large hyperdense right pleural effusion, suggesting passage of blood by diaphragmatic defect 9 . She underwent a laparoscopy which showed approximately one liter of dark red blood and clots in the abdominal cavity, the uterus and adnexa adhered to the colon and pelvic wall, besides lesions resembling endometriosis disseminated throughout the abdomen 9 .…”

“…She underwent a laparoscopy which showed approximately one liter of dark red blood and clots in the abdominal cavity, the uterus and adnexa adhered to the colon and pelvic wall, besides lesions resembling endometriosis disseminated throughout the abdomen 9 . The surgical management included lysis of adhesions and irrigation of the hematoma; after hospital discharge under continuous oral contraception for menstrual suppression, the patient was referred to have the regular follow-up in outpatient gynecology service 9 .…”