Endometriosis: An Unusual Cause of Bilateral Pneumothoraces

Abstract

A 27-year-old female presented to the emergency department with sudden onset shortness of breath. A diagnosis of bilateral catamenial pneumothoraces was made following chest radiograph. Catamenial pneumothorax is a recurrent spontaneous pneumothorax that occurs in 90% of affected women 24-48 hours after the onset of their menstruation; 30-50% of cases have associated pelvic endometriosis. Symptoms can be as simple as chest pain or as severe as the presentation of this patient who was initially found to be in significant respiratory distress.

Catamenial Pneumothorax in a Patient with Endometriosis: A Case Report

“…Catamenial pneumothoraxes present with dyspnea, chest pain, cough, or shoulder pain within 24 hours prior to or up to 72 hours after a menstrual cycle [3,[6][7][8]11]. Another defining characteristic is the lack of symptoms outside of menstruation [12].…”

“…Catamenial pneumothorax is considered an uncommon type of spontaneous pneumothorax, often misdiagnosed as a spontaneous pneumothorax [ 7 - 8 , 11 ]. Prior studies cited the rates of spontaneous pneumothoraxes in females that meet the definition for catamenial pneumothoraxes to be around 3-6%, while more recent literature cites a higher rate, potentially up to 35% [ 7 , 11 ]. Most described cases of catamenial pneumothoraxes involve one lung, with about 85-95% on the right side [ 3 , 11 ].…”

“…Prior studies cited the rates of spontaneous pneumothoraxes in females that meet the definition for catamenial pneumothoraxes to be around 3-6%, while more recent literature cites a higher rate, potentially up to 35% [ 7 , 11 ]. Most described cases of catamenial pneumothoraxes involve one lung, with about 85-95% on the right side [ 3 , 11 ]. About 75% of cases involve asymptomatic or mildly symptomatic pneumothoraxes [ 12 ].…”

A unique case of thoracic endometriosis syndrome and pulmonary Langerhans’ cell histiocytosis: Six recurrent pneumothoraces

“…Non-catamenial endometriosis-related pneumothoraces present an everyday clinical practice challenge as in addition to being rare, a temporal relation with menstruation is not exhibited. The presence of additional pelvic endometriosis and infertility has been reported in patients with TES [ 1 , 4 , 20 ]. An unspecific patient history and the lack of radiological or histological evidence increase the risk of delayed or incorrect diagnosis.…”

Five immune-related genes as diagnostic markers for endometriosis and their correlation with immune infiltration

“…In addition, the reverse flow of endometrial debris can occur any time after menarche while EMS occurs mainly at 25−45 years of age, implying a 10-year lag between the onset of both conditions. Therefore, changes in the intraperitoneal environment, such as an imbalance of the immune system and the invasion, proliferation, and angiogenesis of ectopic endometrial tissue, may play an important role in the pathogenesis of EMS ( 3 ). Research on immune dysfunction may also contribute to disclose the role of the immune system in the pathogenesis of EMS as well as its new diagnosis and treatment strategies.…”