Catamenial Hemoptysis Research Articles

Recurrent catamenial hemoptysis: diagnostic challenges and management strategies—a case report

Catamenial hemoptysis (CH) is a rare, known disease for which diagnosis is crucial and treatment is indefinite. In this case report, CH was identified 2 years ago while taking medical history of the patient. It has disclosed hemoptysis at night with breathlessness that was concurrent with her menses every month for the past 6 months. A series of radiological tests followed by a bronchoscopic examination during menses confirmed the diagnosis. A complex fluid-filled cystic lesion with few air foci in the right lower lobe superior segment with ground glass opacity was seen by a CT scan test. Subsequent bronchoscopy examination showed an active bleeding site at the right lower lobe superior segment. The bronchial wash tests were negative for microbial infections as well as for malignancies. Bronchial artery embolization (BAE) was done and it ceased the hemoptysis. However, it recurred after 2 years of the BAE procedure. The symptoms and amount of hemoptysis were milder; hence, repeated BAE was not required. Earlier, the patient refused hormonal therapy (HT) owing to its side effects, but this time, she accepted HT. After 2 months of HT, hemoptysis gradually ceased. If complications arise in the future, then surgical treatment along with HT (combination therapy) would be the course of treatment. The diagnosis of CH is challenging, and treatment procedures vary from patient to patient; hence, they are customised. Hormones regulate the CH recurrence even though the symptoms have ceased after treatment. Therefore, regular follow-up and close vigilance are crucial requirements.

Evaluation of the Outcome of Interventions for Thoracic Endometriosis Syndrome at a Tertiary Level Health Institution in Southern Nigeria

Background: Thoracic Endometriosis Syndrome (TES) is a clinical condition characterized by the presence of endometrial tissue within the thoracic cavity, catamenial pneumothorax, catamenial haemothorax, catamenial haemopneumothorax, catamenial haemoptysis and or endometrial nodular lung mass. The management can be challenging as treatment is fraught with recurrence.
 Aim: To evaluate the outcome of interventions for Thoracic Endometriosis Syndrome.
 Methods: This was a prospective cross-sectional study of 14 patients with thoracic endometriosis syndrome who were managed at the university of Port Harcourt Teaching Hospital between August 1, 2017, and July 31, 2023. A proforma was used to collect data on socio-demographic characteristics, clinical presentation, type of intervention and evidence of recurrence of chest symptoms and entered into a spread sheet. Data analysis was done with SPSS version 28. Results are presented as frequency tables and percentages.
 Results: The age of the patients ranged between 20 and 44 years. Of the 14 patients, 11 (78.6%) were married, and 3 (21.4%) of the patients had established abdominal endometriosis with symptoms of thoracic endometriosis, while 4 (28.6%) had a histologic diagnosis of thoracic endometriosis. Pneumothorax was observed in 9 (64.23%) patients, 3 (21.43%) had haemopneumothorax, 2 (14.29%) with cyclical haemoptysis and haemothorax, and 4 (28.57%) of the patients had thoracic endometriotic nodules, while all the married patients had primary infertility. Twelve (85.7%) of the patients had closed tube thoracostomy drainage (CTTD) with chemical pleurodesis, while 4 (28.6%) had thoracotomy, decortication, bleb, and nodules resection with chemical pleurodesis. All the patients had hormonal therapy using luteinizing hormone-releasing hormone (LHRH) analogues. There was recurrence in 2 (14.3%) of the patients after a one-to-six-year period of follow-up.
 Conclusion: The treatment of TES using CTTD with pleurodesis, thoracostomy, decortication, bleb resection and or hormonal therapy with appropriate patient selection is effective as only two cases of recurrences were recorded.

Spontaneous recurrent menstrual pneumothorax: a case report

Introduction and importance: Endometriosis is most commonly found in the pelvic area, ~12% of people have it in other areas or organs, which is known as extrapelvic endometriosis. Thoracic endometriosis, which is also classified as extrapelvic endometriosis, manifests with four distinct forms: catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis, or lung nodules. Catamenial pneumothorax is the most common clinical symptom of these; however, it is frequently neglected by clinicians and goes undiagnosed and untreated. As a result, it is critical to raise awareness of this medical condition among clinicians. Case presentation: The authors present a case report of a 34-year-old woman of reproductive age who had recurrent episodes of spontaneous pneumothorax during menstruation and underwent treatment with thoracoscopic surgery as well as gynaecological hormonal drugs including oral progesterone and dienogest throughout this time. Based on her symptoms, a catamenial pneumothorax caused by thoracic endometriosis was suspected. Clinical discussion: The clinical symptoms, pathogenesis, diagnosis, and treatment of Catamenial Pneumothorax are analyzed. Furthermore, the usage of gynaecological hormone medications in this condition has been discussed. The mechanisms of oral contraceptives and progestin-based medications are evaluated by comparing the patient’s treatment process, highlighting their pros and cons. Conclusions: Thoracoscopic surgery combined with postoperative gynaecological hormonal medications may be the most effective treatment for this issue. Several gynaecological hormonal medicines are available, each of which has its own set of pros and cons, and must be thoroughly evaluated as well as correctly tailored to the patient’s specific circumstances to have a positive therapeutic outcome.

Thoracic Endometriosis Syndrome: a case series and review of literature

Background: The presence of endometrial tissue in the tracheobronchial tree, pleural, and lung is normally referred to as thoracic endometriosis. The association of catamenial pneumothorax, catamenial haemothorax, catamenial haemoptysis and pulmonary nodules is referred to as thoracic endometriosis syndrome (TES). TES is rare but not as rare as it has always been thought of.
 Case summaries:
 Case 1: We present EA, a 26-year-old chef/baker who presented to our unit on account of recurrent cyclical right sided chest pain and difficulty in breathing, recurrent haemoptysis and cyclical abdominal pain and swelling with multiple tender umbilical nodules. On general physical examination she was found to be in respiratory distress but not cyanosed with peripheral arterial oxygen saturation 97% on room air. Examination of the chest revealed a right sided chest fullness and reduced movement with breathing. Percussion note was stony dull and absent of breath sound on right hemithorax. Abdominal examination revealed a moderately distended abdomen with positive fluid thrill. Both Pleurocentesis (thoracocentesis) and paracentesis abdominis yielded a haemorrhagic fluid acellular and pleural and lung biopsy demonstrated endometrial stroma and glands. Imaging examination by way of chest X-ray showed a homogenous opacity of the right hemithorax, and pulmonary nodule following drainage. A diagnosis of Thoracic Endometriosis Syndrome was made. She had VAT with lung and pleural biopsy, pleural abrasion and a thoracostomy tube drainage.
 Case 2: We present IAE, a 29year-old Po+0 who presented to our unit on account of recurrent cyclical right sided chest pain and difficulty in breathing, unproductive cough. On general physical examination she was found to be in moderate respiratory distress but not cyanosed with peripheral arterial oxygen saturation of 98% on room air. Chest examination revealed an apical flattering of anterior chest wall with left trachea deviation. Percussion note was stony dull on the right lower third and hyper resonance middle and upper zones of right hemithorax. Pleurocentesis (thoracocentesis) yielded air and haemorrhagic fluid acellular and pleural and lung biopsies demonstrated endometrial stroma and glands. Imaging examination by way of chest X-ray and chest CT-scan showed air fluid level of the right hemithorax. A diagnosis of TES was made. She had Laparoscopy and VAT at the same sitting with pleural and lung biopsies. She was managed medically after closed thoracostomy tube drainage. She had partial collapse of right lower lobe and thoracotomy with right lower lobectomy was planned but patient declined. She also had Stage IV endometriosis by (rASRM)/ENZIAN systems
 Case 3: We present JA a 29-year-old lady, a filling station attendant who presented to our unit with a history of gradual onset of right sided chest pain, progressive difficulty in breathing and non-productive cough, and abdominal pain and swelling. On general physical examination she was found to be in respiratory distress but not cyanosed with SPO2 of 98% on room air. Examination of the chest revealed a right apical flattening, reduced ipsilateral chest movement with breathing. Percussion notes were stony dull and absent air entry on the ipsilateral hemithorax. Abdominal examination showed a mildly distended abdomen with a positive shifting dullness. Both Pleurocentesis (thoracocentesis) and paracentesis abdominis yielded a haemorrhagic fluid acellular at cytology and pleural and lung biopsy demonstrated endometrial stroma and gland. Imaging examination by way of chest X-ray showed a homogenous opacity of the right hemithorax. A diagnosis of Familial Thoracic Endometriosis Syndrome (FTES). Had USS guided lung and pleural biopsy and a thoracostomy tube drainage. She had chemical pleurodesis with tetracycline
 Conclusion: Thoracic endometriosis syndrome is the diagnosis in a lady of reproductive age who present with cyclic or a cyclical recurrent right sided chest pain, cyclical or a cyclical dyspnoea, haemoptysis, cyclical or a cyclical abdominal swelling and peritonitis.

A Case Report of Recurrent Spontaneous Pneumothorax Secondary to Thoracic Endometriosis Syndrome

Endometriosis is a benign condition in which ectopic endometrial glands and stroma are present outside of the uterine cavity. It commonly affects the pelvic organs but can also spread throughout the entirety of the body, including the thoracic cavity. The ectopic presence of endometrial glands and stroma in lung or pleura can produce a range of clinical and radiological manifestations – catamenial pneumothorax, catemenial hemothorax, catamenial hemoptysis, and pulmonary nodules – collectively referred to as “thoracic endometrial syndrome.” Thoracic endometriosis constitutes an uncommon cause of spontaneous pneumothorax in nonsmoking women of childbearing age. Symptoms are often non-specific and the diagnosis is often delayed. A thorough menstrual history and its temporal relationship to pneumothorax onset should be assessed in every women presenting with recurrent pneumothorax. Thoracic endometriosis syndrome is very manageable with the advancements of VATS and hormonal therapy, but we as clinicians should have this on our differential diagnosis when a young, reproductive-aged female presents with a spontaneous pneumothorax to expedite appropriate care. Here we present a case of a 44 year old female with recurrent spontaneous pneumothorax that was attributed to thoracic endometriosis that will hopefully educate providers to have a high clinical suspicion in patients to obtain an accurate diagnosis and initiate proper treatment.

Catamenial Hemoptysis Managed With Medroxyprogesterone Acetate: A Management Dilemma

Catamenial Hemoptysis Managed With Medroxyprogesterone Acetate: A Management Dilemma

Thoracic endometriosis syndrome in Nigeria: a single-centre experience.

Thoracic endometriosis syndrome (TES) is the presence of functional endometrial tissue in or around the lung. There seem to be differences in the clinical presentation of this condition among Nigerian patients. We aim to study the clinical presentation and management outcome of TES in our centre. This is an analysis of consecutive patients with TES treated over a 5-year period and followed up for 6 months to 5 years. Information collected included the gynaecological history, clinical presentation, causes of misdiagnosis, modalities of treatment and outcome. Twenty-three patients with TES aged between 24 and 45 years (median 32 years) were treated. Severe dysmenorrhoea was a prominent symptom in 91.3% of cases (median dysmenorrhoea score 8) and was uninfluenced by the marital status (P = 0.522). The patients usually presented with massive or recurrent haemothorax associated with massive ascites [16/23 (69.5%) of cases (P = 0.0006)]. The right side alone was involved in 21 cases and 1 patient had catamenial haemoptysis as a part of her symptoms, even though there was bronchial bleed at bronchoscopy in 6 patients. In 40%, tuberculosis was the misdiagnosis. Diagnosis was established histologically in 18/23 (78.3%) of the cases. Treatment was multimodal and multidisciplinary with notable macroscopic lesions in 77.8% of the patients that had surgery. TES is not an uncommon lesion. Presentation with massive haemothorax is usually associated with massive ascites. A large percentage of such have pleural and diaphragmatic lesions that require surgical treatment. The ascites may be refractory to treatment requiring repeated paracentesis.

Extra-pelvic endometriosis: A review.

BackgroundExtra‐pelvic endometriosis is a rare type of endometriosis, which occurs in a distant site from gynecological organs. The diagnosis of extra‐pelvic endometriosis can be extremely challenging and may result in a delay in diagnosis. The main objective of this review was to characterize abdominal wall endometriosis (AWE) and thoracic endometriosis (TE).MethodsThe authors performed a literature search to provide an overview of AWE and TE, which are the major types of extra‐pelvic endometriosis.Main findingsAbdominal wall endometriosis includes scar endometriosis secondary to the surgical wound and spontaneous AWE, most of which occur in the umbilicus or groin. Surgical treatment appeared to be effective for AWE. Case reports indicated that the diagnosis and treatment of catamenial pneumothorax or endometriosis‐related pneumothorax (CP/ERP) are challenging, and a combination of surgery and postoperative hormonal therapy is essential. Further, catamenial hemoptysis (CH) can be adequately managed by hormonal treatment, unlike CP/ERP.ConclusionEvidence‐based approaches to diagnosis and treatment of extra‐pelvic endometriosis remain immature given the low prevalence and limited quality of research available in the literature. To gain a better understanding of extra‐pelvic endometriosis, it would be advisable to develop a registry involving a multidisciplinary collaboration with gynecologists, general surgeons, and thoracic surgeons.

ENDOMETRIOSIS OF THE LUNG PRESENTING AS INNUMERABLE NODULES

ENDOMETRIOSIS OF THE LUNG PRESENTING AS INNUMERABLE NODULES

Recurrent hemoptysis in a 26-year-old woman with a ground-glass opacity lesion of the lung.

Hemoptysis is a major reason for emergency department (ED) visits. Catamenial hemoptysis (CH), a rare condition of thoracic endometriosis, can cause recurrent hemoptysis but is difficult to diagnose in the ED due to the scarcity of cases and nonspecific clinical findings. We report a case of a 26-year-old woman who presented to the ED with recurrent hemoptysis since 2 years without a definite cause. Her vital signs and blood test findings were unremarkable. Chest computed tomography (CT) did not show any specific lesions other than a non-specific ground-glass opacity pattern in her right lung. She was on day 4 of her menstrual cycle and her hemoptysis frequently occurred during menstruation. Although there was no histological confirmation, based on her history of hemoptysis during menstruation and no other cause of the hemoptysis, the patient was tentatively diagnosed with CH and was administered gonadotropin-releasing hormone. She had no recurrence of hemoptysis for 3 months. While CH is difficult to diagnose in the ED, the patient’s recurrent hemoptysis related to menstruation was a clue to the presence of CH. Therefore, physicians should determine the relationship between hemoptysis and menstruation for women of childbearing age presenting with repeated hemoptysis without a definite cause.

Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management.

Background:Endometriosis is characterized by the presence of endometrial-like glands and stroma outside the uterine cavity and is believed to affect 6%–10% of reproductive-age women. Endometriosis within the lung parenchyma or on the diaphragm and pleural surfaces produces a range of clinical and radiological manifestations. This includes catamenial pneumothorax, hemothorax, hemoptysis, and pulmonary nodules, resulting in an entity known as thoracic endometriosis syndrome (TES).Database:Computerized searches of MEDLINE and PubMed were conducted using the key words “thoracic endometriosis,” “catamenial pneumothorax,” “catamenial hemothorax,” and “catamenial hemoptysis.” References from identified sources were manually searched to allow for a thorough review.Conclusion:TES can produce incapacitating symptoms for some patients. Symptoms of TES are nonspecific, so a high degree of clinical suspicion is warranted. Medical management represents the first-line treatment approach. When this fails or is contraindicated, definitive surgical treatment for cases of suspected TES uses a combined video laparoscopy performed by a gynecologic surgeon and video-assisted thoracoscopic surgery performed by a thoracic surgeon. Postoperative hormonal suppression may further reduce disease recurrence.

Thoracic endometriosis syndrome at University of Ilorin Teaching Hospital.

Background Endometriosis is defined as the presence of endometrial tissue (stroma and functional glands) outside the uterine cavity in women of reproductive age. Ectopic sites are frequently located in the pelvis; extrapelvic sites have been reported in the gastrointestinal tract and thoracic cavity. Thoracic manifestation of endometriosis constitutes thoracic endometriosis syndrome (TES). Objectives To examine the presentation pattern and outcome of in the management of TES. Methods This study is a retrospective review of medical records of patients diagnosed with endometriosis at the University of Ilorin Teaching Hospital over a 3.5-year period from January 2014 to June 2017. Results A total of 21 patients presented with endometriosis, of whom 8 (38.1%) presented with TES. The most common variety of TES was catamenial pleural effusion (CPE) accounting for 75%, followed by catamenial chest pain (37.5%). Two patients (25%) each presented with catamenial pneumothorax and catamenial haemoptysis, while 1 (12.5%) had catamenial surgical emphysema. Closed thoracostomy tube drainage plus chemical pleurodesis was the most frequent intervention technique, accounting for 62.5%. Conclusion TES remains an uncommon entity, despite being the most common extrapelvic manifestation of endometriosis. CPE appeared to be the most common variant of TES in our environment. Currently available treatment options need to be improved, and more use made of video-assisted thoracoscopic surgery.

Thoracic endometriosis syndrome: Comparison between catamenial pneumothorax or endometriosis-related pneumothorax and catamenial hemoptysis

ObjectivesTo evaluate the clinical features of thoracic endometriosis syndrome (TES) represented by catamenial pneumothorax (CP), endometriosis-related pneumothorax (ERP), and catamenial hemoptysis (CH). Study designIn this retrospective study, we enrolled 25 patients with TES, 18 of whom had CP/ERP and 7 had CH, to investigate the clinical presentation, effectiveness of treatment, and recurrence rates in these disorders. ResultsThe age at onset was significantly lower in patients with CH than in patients with CP/ERP (P < 0.05). In 94.4% of patients with CP/ERP, pneumothorax was observed on either the right side or bilaterally, however there was no tendency toward laterality of CH among our cases. In our study, patients with CP/ERP predominantly underwent surgical management and the recurrence rate during treatment was higher in patients with CP/ERP than in those with CH. We found that the recurrence frequency of CP/ERP was lowest under the combination therapy with thoracic surgery and postoperative hormonal therapy. ConclusionOur findings suggest that CP/ERP and CH are different pathological conditions and CP/ERP is more difficult to manage than CH.

Endométriose thoracique compliquée de pneumopéricarde et pneumothorax itératifs sur dystrophie bulleuse

Thoracic endometriosis is a rare entity characterized by presence of endometrial tissue in pleura, lung parenchyma or airways. Most frequent manifestations are catamenial pneumothorax, hemothorax, hemoptysis and pulmonary nodules. We report here a rare case of a woman with thoracic endometriosis who developed iterative pneumothorax and pneumopericardium on bilateral bullous pulmonary dystrophy. She was a 37-year-old woman without any tobacco exposure and with previous history of pleural tuberculosis treated 5 years earlier. She was first referred to our centre for right pleuro-pneumothorax and hemorrhagic ascites. Pleural fluid examinations did not show any tuberculosis relapse, the evolution was favorable after thoracic drainage and there was no parenchymal lung abnormality on CT scan after surgery. Celioscopic peritoneal examination revealed stage IV peritoneal endometriosis. One year later, she was admitted for left catamenial pneumothorax. Thoracic CT scan showed apparition of large subpleural bulla. She underwent thoracotomy for bulla resection and left partial pleurectomy. Two years later, she was hospitalized for right pneumothorax and compressive pneumopericardium. Surgical lung biopsies confirmed pleuropulmonary endometriosis. Thoracotomy was performed for talcage pleurodesis and diaphragmatic leakages sutures. Lung bulla are rare in thoracic endometriosis, mechanism of their formation remains unknown. Pericardial involvement is rare in endometriosis; we report here a unique case of pneumopericardium.

A very rare cause of hemoptysis and chest pain lung endometriosis. A case report

Hemoptysis can be caused by multiple conditions like tuberculosis, malignancies, bronchiectasis or pulmonary embolism. Sometimes, hemoptysis can be caused by other diseases, like vasculitis, lymphangioleiomiomatosis or other rare diseases. We present a clinical case of an 18 years old woman with recurrent mild hemoptysis. Thoracic computer tomography (CT) showed ground glass opacity and small micronodules in the right upper lobe. A thorough anamnesis revealed that the patient had catamenial hemoptysis that raised the hypothesis of pulmonary endometriosis, which is a challenge for every clinician. Spontaneous regression after one month and the repeated hemoptysis after five months linked to menstruation along with the same aspect on CT raised the diagnosis of thoracic endometriosis syndrome.The thoracic endometriosis is a rare and complex condition affecting women at childbearing age. The diagnosis is frequently difficult and histopathological confirmation is often required for positive diagnosis. Moreover, if the patient has typical clinical history and other differential diagnosis are ruled out, a presumptive diagnosis can be achieved.

Aromatase inhibitor therapy in a cystic fibrosis patient with thoracic endometriosis

The thoracic cavity is the number one site for extrapelvic endometriosis, with catamenial pneumothorax as the most common presenting symptom. Its treatment algorithm is similar to the one for pelvic endometriosis, with the goal of inducing a hypoestrogenic state. However, if medical treatment fails, lung resection may be the only option. We present a case of a 44-year-old female with cystic fibrosis and known pelvic endometriosis, who was diagnosed with thoracic endometriosis after presenting with catamenial hemoptysis. After having a recurrence more than four years after a bilateral salpingo-oophorectomy, she was started on aromatase inhibitor (AI) therapy to avoid lung resection. Such therapy with an AI successfully treated recurrent thoracic endometriosis in a patient with cystic fibrosis, i.e. not an ideal candidate for lung resection.

Aromatase inhibitor therapy in a cystic fibrosis patient with thoracic endometriosis

The thoracic cavity is the number one site for extrapelvic endometriosis, with catamenial pneumothorax as the most common presenting symptom. Its treatment algorithm is similar to the one for pelvic endometriosis, with the goal of inducing a hypoestrogenic state. However, if medical treatment fails, lung resection may be the only option. We present a case of a 44-year-old female with cystic fibrosis and known pelvic endometriosis, who was diagnosed with thoracic endometriosis after presenting with catamenial hemoptysis. After having a recurrence more than four years after a bilateral salpingo-oophorectomy, she was started on aromatase inhibitor (AI) therapy to avoid lung resection. Such therapy with an AI successfully treated recurrent thoracic endometriosis in a patient with cystic fibrosis, i.e. not an ideal candidate for lung resection.

Thoracic Endometriosis Syndrome: A Veritable Pandora's Box.

Thoracic endometriosis syndrome is a rare disorder characterised by the presence of functioning endometrial tissue in pleura, lung parenchyma, airways, and/or encompasses mainly four clinical entities-catamenial pneumothorax, catamenial haemothorax, catamenial haemoptysis and lung nodules. The cases were studied retrospectively by reviewing the records at Amrita Institute of Medical Sciences, for duration of five years i.e., form March 2010-2014 and analysed for the clinical presentation and management of thoracic endometriosis syndrome. Catamenial breathlessness was the main symptom. Pneumothorax and pleural effusion were the findings on investigations. Histopathology report of endometriosis was present in three cases (50%). Conditions with excess oestrogen like endometriosis, fibroid, adenomyosis were diagnosed in these patients by pelvic scan. After the initial supportive treatment with hormones, pleurodesis, hysterectomy and lung decortication were the treatment modalities. Two cases that had multiple recurrences were diagnosed as disseminated TES. They underwent combined treatment of surgery and hormones.

Clinical features of thoracic endometriosis: A single center analysis.

ObjectiveTo analyze the diagnostic profiles and treatment outcomes of patients with thoracic endometriosis at a university hospital.MethodsA retrospective review of medical records was performed for patients diagnosed with thoracic endometriosis at Gangnam Severance Hospital, Yonsei University College of Medicine, between January 2007 and January 2014.ResultsFifteen patients (median age, 35 years; range, 23-48 years) were evaluated. Patients presented with catamenial hemoptysis (n=8), or catamenial pneumothorax (n=7). Patients with catamenial pneumothorax were significantly older than those presenting with hemoptysis (P=0.0002). Only 3 patients (20%) had coexisting pelvic endometriosis. All patients underwent chest computed tomography; lesions were shown to predominantly affect the right lung (right lung, n=13, 86.7%; left lung, n=2, 13.3%), and were mainly distributed on the right upper lobe (n=9, 60%). Ten patients underwent video-assisted thoracoscopic surgery, and 1 patient underwent a thoracotomy. Intraoperatively, endometriosis-specific findings were observed in 8/11 patients (72.7%); a further 5/11 patients (45.4%) had histologically detectable endometriosis. Over the follow-up period (mean, 18.4 months; range, 2-65 months) 5/15 patients (33%) had clinical signs of recurrence. Recurrence was not detected in any of the 5 catamenial pneumothorax patients that received adjuvant hormonal therapy after surgery.ConclusionThe diagnosis and management of thoracic endometriosis requires a multidisciplinary approach, based upon skillful differential diagnosis, and involving careful gynecologic evaluation and assessment of the cyclicity of pulmonary symptoms. Imaging findings are non-specific, though there may be laterality towards the right lung. Since symptom recurrence is more common in those with presenting with pneumothorax, post-operative adjuvant medical therapy is recommended.

Catamenial pneumothorax.

Catamenial pneumothorax (CP) is the most common form of thoracic endometriosis syndrome, which also includes catamenial hemothorax, catamenial hemoptysis, catamenial hemopneumothorax and endometriosis lung nodules, as well as some exceptional presentations. Usually onset of lung collapse is less than 72 hours after menstruation. Most commonly occurs in women aged 30-40 years, but has been diagnosed in young girls as early as 10 years of age and post menopausal women (exclusively in women of menstrual age) most with a history of pelvic endometriosis. Diagnosis can be hinted by high recurrence rates of lung collapse in a woman of reproductive age with endometriosis. Moreover; CA-125 is elevated. Video-assisted thoracoscopy or medical thoracoscopy is used for confirmation. In our current work we will present all aspects of CP from diagnosis to treatment.