Catamenial pneumothorax: A neglected diagnosis

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Background. Catamenial pneumothorax (CP) is an under-reported and misunderstood condition commonly defined as a recurrent, spontaneous pneumothorax occurring from the day before menstruation until 72 hours after its onset. It is the most common clinical manifestation of thoracic endometriosis. Case report. We describe the case of a 36-year-old woman who presented twice with significant shortness of breath during her menses at a regional hospital in Gauteng Province, South Africa. Chest radiographs showed bilateral spontaneous pneumothoraces on both occasions, indicating a very rare presentation of CP, which is more commonly a right-sided pathology and a rare presentation on its own. Video-assisted thoracoscopic surgery was performed at a tertiary institution. Significant thoracic endometriosis and a diaphragmatic hernia were found, confirming the diagnosis of endometriosis-related CP. Pleurectomy and closure of the diaphragmatic hernia were performed, and the patient was initiated on hormonal therapy. Conclusion. A high index of clinical suspicion is required for diagnosing CP and its associated conditions. This case highlights the need for awareness of this condition and the importance of long-term follow-up, especially in an overburdened and resource-limited healthcare system.