Catamenial Pneumothorax: Surgical Repair of the Diaphragm and Hormone Treatment

Abstract

Catamenial pneumothorax is defined as spontaneous pneumothoraces occurring within 72 h before or after onset of menstruation. It is rare but clinical index of suspicion should be high in ovulating women with spontaneous pneumothoraces. The mechanism is unclear but is thought to involve pre-existing or acquired diaphragmatic defects and endometrial implants. Traditional therapy involving hormonal treatment or surgical pleurodesis alone is associated with high rates of recurrence. A series of four patients with catamenial pneumothorax managed at our institution is presented to highlight the condition to various surgical specialties to whom it may present, and to emphasise the importance of both surgical and hormonal interventions in preventing recurrence. Each patient underwent video-assisted thoracoscopic inspection of the diaphragm, mechanical pleurodesis and, most importantly, repair of diaphragmatic defects with an artificial mesh. Surgical treatment was strictly followed by a course of gonadotrophin-releasing hormone analogue therapy in three patients, with no recurrence to date (longest follow-up 45 months). The fourth patient suffered a postoperative recurrence when hormonal treatment was delayed for 6 weeks, stressing the importance of hormonal treatment in conjunction with surgery.

Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010

“…This variability reflects the general lack of success with surgical intervention alone, recurrence rates of up to 30% being documented 194. When combined with gonadotrophin-releasing hormone analogues amenorrhoea results, but recurrence has been avoided with follow-up approaching periods of 4 years 195. Successful patient management requires close cooperation between respiratory physicians, thoracic surgeons and gynaecologists.…”

A case of diaphragmatic clear cell carcinoma in a patient with a medical history of ovarian endometriosis

“…Diaphragmatic endometriosis sometimes accompanies pelvic endometriosis, and predominantly occurs on the right side. Clockwise peritoneal circulation from the pelvis to the right subphrenic space sweeps endometrial implants to the right diaphragm [3]. Therefore, clear cell carcinoma seen in the present case may have originated from the endometriosis that had been implanted from ovarian endometriosis onto the diaphragm.…”

Catamenial pneumothorax: a case report of recurrent spontaneous pneumothorax

“…Because of high incidences of postoperative recurrence, medical treatment should be combined with the surgical treatment. Gonadotropic hormone analogues should be administered to the patients for 3-6 months in order to allow the pleurodesis to take effect [6]. Our patient had a recurrent episode of CP after she stopped taking her medical treatment that only lasted for a month.…”