Catamenial Pneumothorax as the First Expression of Thoracic Endometriosis Syndrome and Pelvic Endometriosis

Paola Ciriaco,Giampiero Negri,Angelo Carretta,Jessica Ottolina,Piergiorgio Muriana,Massimo Candiani

doi:10.3390/jcm11051200

Paola Ciriaco, Giampiero Negri + Show 4 more

Open Access

https://doi.org/10.3390/jcm11051200

Copy DOI

Abstract

Objective: The menstrual-related catamenial pneumothorax (CP) can be the first expression of thoracic endometriosis syndrome (TES), which is the presence of endometriotic lesions in the lungs and pleura, and pelvic endometriosis (PE). This study aims to analyze our experience with this specific correlation describing our multidisciplinary approach to CP. Methods: Hospital records of 32 women, operated for CP at our Department from January 2001 to December 2021 were reviewed. Surgical treatment consisted of videothoracoscopy and laparoscopy when indicated. Results: TES and PE were diagnosed in 13 (40.6%) and 12 (37.5%) women, respectively. The association of TES and PE was present in 11 cases (34%). Fifteen patients (46.9%) underwent laparoscopy, of which 11 concurrently with videothoracoscopy. Most of the patients affected had stage III–IV endometriosis (40.6%). All patients received hormonal therapy after surgery. Five patients with PE conceived spontaneously resulting in six live births. The mean follow-up was 117 ± 71 months (range 8–244). Pneumothorax recurrence occurred in six patients (18.8%). At present, all women are asymptomatic, with no sign of pneumothorax recurrence. Conclusions: CP might be the first expression of TES and/or PE. A multidisciplinary approach is advocated for optimal management of the disease.

Highlights

Catamenial pneumothorax (CP) is defined as recurrent spontaneous pneumothorax occurring between 24 h before and 72 h after the onset of menstruation
Endometriosis seems to play an important role in the development of CP considered one of the most frequent expressions of Thoracic endometriosis syndrome (TES) [15,16], and the association with pelvic endometriosis (PE) has been reported in 20–70% of patients [7,16,17]
CP is treated as a respiratory disease in the majority of cases, but it is recognized that it can be the expression of TES and is frequently associated with PE [7,24,25,26,27]

Summary

Introduction

Catamenial pneumothorax (CP) is defined as recurrent spontaneous pneumothorax occurring between 24 h before and 72 h after the onset of menstruation. It has always been considered an unusual condition [1], but since its recognition has improved, its frequency is currently quoted as 23 to 30% of pneumothoraxes among women [2]. Thoracic endometriosis syndrome (TES) refers to the presence of endometriotic lesions in the lungs and pleura and comprises four clinical entities, namely catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis, or lung nodules [4].

Objectives

Methods

Results

Discussion

Conclusion