Treatment Of Catamenial Pneumothorax Research Articles

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.

Meigs syndrome after treatment for catamenial pneumothorax

In the field of thoracic surgery, catamenial pneumothorax (CP) is known as a disease peculiar to women, but it is rare among female pneumothoraces and is rarely encountered in clinical practice. Meigs syndrome (MS) is another female-specific disease, defined as a benign ovarian tumor with pleural and ascites effusions, but it is rare and the details of the pathogenesis of MS have not yet been elucidated.A 40-year-old Japanese woman came in with dyspnea. Chest radiography revealed a collapsed right lung. She underwent video-assisted thoracoscopic surgery, which revealed multiple diaphragmatic foramens. She was therefore diagnosed with CP. Later, when she was 50-year-old, returned with chest pain. Computed tomography of the chest and abdomen showed right massive pleural effusion and a large tumor and ascites in the pelvis. This condition was suggestive of MS. The patient underwent bilateral oophorectomy, and the right pleural effusion and ascites resolved promptly after surgery.In conclusion, both menstrual-associated CP and MS are very rare conditions, and to the best of our knowledge, there are no reported cases of the combination of the two. However, it is possible that some MS patients may have MS without CP, and the present case is considered to be valuable because a small diaphragmatic foramen was identified via thoracoscopy, which has been a minority opinion among the mechanisms of pleural effusion in MS.

Catamenial pneumothorax – are there benefits of cooperation between the surgeon and the gynaecologist?

Catamenial pneumothorax (CP) is an uncommon disease related to thoracic endometriosis or diaphragmatic perforation. It is defined as an occurrence of spontaneous pneumothorax around the time of menstruation in the population of women of reproductive age with no other lung diseases. Catamenial pneumothorax is often misdiagnosed and classified as a spontaneous pneumothorax, and no in-depth gynaecological diagnostic is performed. Here we present 3 cases of female patients admitted to the Department of Thoracic Surgery with the aim of surgical treatment of recurrent CP. In all 3 cases, a temporal association between pneumothorax and menstruation was identified. In 2 presented cases the patients were diagnosed with endometriosis and other gynaecological diseases. The previous incidents of CP were treated conservatively, with suction drainage of the pleural cavity or with thoracocentesis, but the treatment did not prevent relapses. In the Department of Thoracic Surgery, each patient was operated on with the use of video-assisted thoracoscopic surgery, which is considered to be a good therapeutic option. In the case of 2 patients the surgery eliminated the relapses, 1 patient required radical lung decortication. The literature on the subject indicates the potential benefits of hormonal treatment of CP. It is suggested that using such pharmacological treatment may reduce the risk of relapse after surgery.

CATAMENIAL CONUNDRUM: A CASE OF PULMONARY EMBOLISM IN A PATIENT WITH CATAMENIAL PNEUMOTHORAX

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Endometriosis is a common condition affecting about 10% of reproductive-age women, in which ectopic endometrial tissue is found outside of the uterine cavity [1]. While it most commonly affects the pelvis, rarely endometrial tissue can also be found in the chest, often presenting as catamenial pneumothorax [2]. There have also recently been reports of systemic effects of endometriosis such as supporting a pro-inflammatory and prothrombotic state, increasing the risk for deep vein thrombosis (DVT) and pulmonary embolism (PE) [3]. CASE PRESENTATION: A 32 year old woman with endometriosis presented to the hospital with several weeks of pleuritic chest pain, nausea, vomiting, and inability to tolerate oral intake. Several months prior, she was diagnosed with thoracic endometriosis after a hospitalization for chest pain and discovery of bilateral pneumothoraces and pleural effusions, necessitating bilateral chest tube placement. Her consequent outpatient course was complicated by an unprovoked DVT, for which she was started on apixaban. She was admitted to the hospital the next month for worsening dyspnea and underwent computed tomography angiography of the chest and was found to have a left lower lobe subsegmental pulmonary embolism and loculated bilateral pneumothoraces, leading to video-assisted thoracoscopic surgery with decortication, pleural biopsy, and chemical pleurodesis for catamenial pneumothorax, with improvement in symptoms (Image 1). Anticoagulation (AC) was switched from oral apixaban to enoxaparin injections 1.5mg/kg daily, with a plan for clinic follow up for further AC management. DISCUSSION: Extrathoracic involvement is a rare and challenging presentation of endometriosis, often necessitating invasive interventions, and associated with recurrence rates of up to 14% (4). Our patient presented the challenge of requiring AC for her PE while managing bleeding risk in the setting of endometriosis, all while being unable to tolerate oral medications due to nausea and vomiting associated with endometriosis. In such patients, injectable, quickly reversible options for AC such as enoxaparin should be considered. CONCLUSIONS: There have been several studies suggesting that endometriosis supports a prothrombotic state, making it imperative to remember this dual challenge when treating endometriosis patients, and to have a low threshold for suspecting PE in any patient with persistent chest discomfort even after treatment of catamenial pneumothorax. Management should be individualized, with attention to the effect of related systemic complications such as nausea and vomiting precluding oral medication success to prevent potentially devastating consequences. REFERENCE #1: Shafrir AL, Farland LV, Shah DK, et al. Risk for and consequences of endometriosis: A critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol. 2018;51:1-15. REFERENCE #2: Mecha E, Makunja R, Maoga JB, et al. The Importance of Stromal Endometriosis in Thoracic Endometriosis. Cells. 2021;10(1):180. Published 2021 Jan 18. REFERENCE #3: Ding D, Liu X, Guo SW. Further Evidence for Hypercoagulability in Women With Ovarian Endometriomas. Reprod Sci. 2018;25(11):1540-1548. DISCLOSURES: No relevant relationships by Teressa Ju, source=Web Response No relevant relationships by Gina Villani, source=Web Response No relevant relationships by Angelina Voronina, source=Web Response

Extragenital endometriosis as a cause of catamenial pneumothorax in women: own experience

Introduction. Catamenial pneumothorax is one of the most difficult to diagnose types of spontaneous pneumothorax in women. The cause of the latter is ectragenital localization of endometriosis. To date, there is no clear pathogenetically determined treatment and treatment algorithm for the management of this category of patients. Objective: to analyze and structure our own experience in the treatment of catamenial pneumothorax. Materials and methods. For the period 2011–2020 in the Thoracoabdominal Department of the SI "Zaytcev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine" 7 women with catamenial pneumothorax were on inpatient treatment. Results. After additional examination, all patients underwent draining of the pleural cavity with Bulau as the first stage after the diagnosis was established. At the second stage, all patients underwent minimally invasive surgical interventions – videothoracoscopic resection of the endometriosis-affected areas of the costal parietal pleura and diaphragm, mechanical pleurarasion and pleurodesis, using fibrin-collagen plates in the areas of diaphragm defects. There were no postoperative complications or deaths. Conclusion. In the treatment of extragenital endometriosis complicated by catamenial pneumothorax, not only thoracic surgeons, but also obstetrician-gynecologists should take part in order to create multidisciplinary commissions aimed primarily at determining the pathogenetically determined treatment tactics. Key words: extragenital endometriosis, catamenial pneumothorax, videothoracoscopy, surgical treatment.

Diagnosis and Treatment of Catamenial Pneumothorax: A Report of a Single-Center Experience

Introduction: Catamenial pneumothorax (CP) is defined as spontaneous pneumothorax occurring within 72 hours before or after the onset of menstruation. Its etiology is not well understood, and its management remains controversial. Methods: A retrospective review was carried out in all female patients with spontaneous pneumothorax who were treated at our department, the last 20 years. Result: Five patients were suffered of CP. The median age was 27.4 (21-33). The side of the pneumothorax was right in four patients and bilateral in one. None of them were diagnosed with endometriosis. Four were treated surgically, while the last one was managed conservatively. Small fenestrations on the central tendon of the diaphragm was found in one patient. The mean hospital stay was 6.2 days. The follow-up examination did not confirm any recurrence. Conclusion: In this study, we investigated the clinical features of CP. A menstrual history and its temporal relation to a pneumothorax should be assessed on every woman presenting with recurrent pneumothorax. Surgical treatment must be selected as definitive for CP and must be combined with hormone therapy, as it prevents recurrence.

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.

Nine cases of catamenial pneumothorax: a report of a single-center experience.

Catamenial pneumothorax (CP) is defined as repeated pneumothorax related to menses and thoracic endometriosis. We performed a retrospective analysis of nine patients with CP to determine the clinical features as well as the effects of treatment and recurrence rates. A retrospective review was conducted of the clinical and pathologic data in all CP patients undergoing treatment at our institution. Nine patients underwent treatment for CP. Of these, six underwent surgical treatment 8 times. The median age was 36 years. Six patients had experienced delivery. The laterality of the pneumothorax was right in all patients. Pelvic endometriosis was diagnosed in five patients. Six patients underwent surgical treatment. Partial resection of the lung was performed in four patients and partial resection of the diaphragm in five. Of these, both resections were performed in four patients. A pathological diagnosis of endometriosis was achieved in only three patients. The observation period was 16.7 months. In the six patients with surgical resection, five experienced recurrence at various intervals. Onset of pneumothorax occurred pre- or menstrual period in most cases. The diagnosis and treatment of CP is not easy. A multidisciplinary approach and skillful management are required. Recurrence of CP is common following a temporary cure of pneumothorax by surgical treatment.

КАТАМЕНІАЛЬНИЙ ПНЕВМОТОРАКС: НОВІ ПОГЛЯДИ Й МІРКУВАННЯ

Мета дослідження – вивчити особливості діагностики та лікування катаменіального пневмотораксу (КП).Матеріали та методи. Пацієнтка віком 33 р. перебувала на лікуванні в КМКЛ № 17 з 12.07.13 по 16.07.13 та з 21.08.13 по 02.09.13. Їй проводили повний клініко-діагностичний комплекс обстежень та лікування відповідно до діючих протоколів.Результати дослідження та їх обговорення. У статті представлено огляд літератури з питання КП та подано опис клінічного випадку, а також узагальнено особливості діагностики та лікування КП. Сучасні міні-інвазивні способи хірургічних втручань та раціональна консервативна терапія є методом вибору в діагностиці та лікуванні КП. Всебічне дообстеження є необхідною передумовою для вибору раціональної тактики подальшого лікування. Консенсусу щодо оптимальних доз та строків гормональної терапії дотепер не досягнуто.Висновки. До сьогодні ендометріоз залишається малодослідженим захворюванням, а його поширеність у світовій популяції досягає 11 %. Оптимальні результати лікування досягаються за умови комплексного підходу із залученням суміжних фахівців, у т. ч. гінекологів.

Results of treatment for catamenial pneumothorax since the introduction of video-assisted thoracoscopic surgery: a systematic review

Catamenial pneumothorax is an uncommon form of pneumothorax in women of reproductive age (1); it is strongly related to endometriosis and menses. Diaphragmatic changes, such as holes or endometrial implants, were features in patients with catamenial pneumothorax (2). Endometriosis of the visceral pleura was sometimes observed (2,3). Although some theories have been suggested, the etiology is not known in detail. Treatment was difficult because patients with catamenial pneumothorax have frequent recurrences (2). Optimal treatments for catamenial pneumothorax have not been conclusively confirmed. We need to understand the etiology or pathophysiology of the disease to resolve these problems, including recurrences in patients with catamenial pneumothorax. For that reason, the report by Bricelj et al. (1) is very important, and focusing on the period after the introduction of video-assisted thoracoscopic surgery (VATS) is informative.

What Is the Best Treatment for Catamenial Pneumothorax?

We read with interest the article by Seok and Lee[1] presenting the case of a left-sided catamenial pneumothorax (CP) associated with diaphragmatic fenestrations. CP is considered a rare disease, but, as reported in a recent review, its incidence amounts to 25% of spontaneous pneumothorax in surgically treated women.[2] It is more frequently located on the right side because, supposing that endometrial cells reach the thorax from the peritoneal space, the transportation occurs by a preferential clockwise peritoneal fluid current from the pelvis along the right paracolic gutter up to the subphrenic space. Cells would implant more easily on the right diaphragmatic leaf as they are stuck there by the falciform ligament[3] and “piston effect” exerted by the liver,[4] whereas the soft and compressible viscera of the left upper quadrant cannot exert such activity.

Treatment of catamenial pneumothorax with absorbable mesh, pleurectomy and pleural abrasion

We read with interest the paper by Ikeda et al. [1] regarding the treatment of catamenial pneumothoraces. We agree with the authors that the pathology of true catamenial pneumothorax is not clear. However, in most cases, diaphragmatic fenestrations play a role. On the left, the fenestrations are frequently plugged by the omentum. On the right, however, the liver prevents such plugging, which accounts for the right-sided prevalence of the catamenial pneumothorax. We too have used an absorbable mesh in the treatment of catamenial pneumothoraces for a number of years with good results; however, our practice differs from the one described by the authors. We have satisfactory results fixing the patch to the diaphragm without applying a patch to the lung tissue [2]. Our ability to inspect the diaphragm has improved, and our technique has evolved with the introduction of thoracoscopy. Whereas previously, via a muscle-sparing thoracotomy, we would have sutured a polygalactin mesh over the defects in the diaphragmatic surface, we now use an endoscopic tacker (The ProTack™ 5-mm Fixation Device, Covidien, UK) to fix the patch at thoracoscopy. This can be added to the standard pleurectomy and abrasion technique using three thoracoscopic ports. We would recommend that any surgeon operating on a female patient for pneumothorax should examine the diaphragm and treat any defects appropriately.

An effective method of pleurodesis involving absorbable mesh for repetitive catamenial pneumothorax

Catamenial pneumothorax (CPX) is an aetiologically very complex disease for which the treatments for pneumothorax and endometriosis are generally adapted. However, emphasizing secondary prevention, we developed a new method. This powerful new technique for prevention of pneumothorax during menstruation by surgical pleurodesis using absorbable mesh is presented. CPX is a relatively rare disease characterized by recurrent pneumothorax during menstruation. Although pathological diagnosis is desirable, CPX is clinically defined as recurrent pneumothorax synchronized with the menstrual cycle. Unfortunately, conventional therapy, including hormonal treatment and surgical procedures, seems to be associated with a high rate of recurrence; there is no well-established treatment for CPX. Recently, we developed a useful and effective operative method for spontaneous pneumothorax, with which one can remove the lesion site and sew a polyglactin mesh on the lung concurrently by endoscopic linear cutter under video-assisted thoracoscopic surgery, dressing the lung with polyglactin mesh to reinforce the stump and facilitating pleural adhesion for secondary prevention. We have used this method to resect pathological lung lesions and promote pleurodesis to prevent recurrence. In addition, polyglycolate felt was placed to cover the lesion site in the diaphragm in four cases of repetitive and treatment-resistant CPX as surgical pleurodesis, and successful results were obtained.

Long-Term Hormonal Treatment for Recurrent Catamenial Pneumothorax

Catamenial pneumothorax is a rare complication of endometriosis. Although fatal, no long-term therapies have been revealed to be efficacious in preventing this disorder. This report discusses two cases of catamenial pneumothorax managed with norethindrone acetate over an extended period of time. The patients responded well without recurrence of pneumothorax during treatment. While current therapies are generally used for a six month to one year period, we present a long-term, highly efficacious, and inexpensive treatment for catamenial pneumothorax in patients with endometriosis.

Catamenial Pneumothorax: Report of a Case

Catamenial pneumothorax is a rare disease, with only over two hundred cases reported since 1958. Its exact cause is still unknown, though many etiologies have postulated. We present a 37-year-old non-smoking female whose menstruation was concurrent with recurrent right-sided spontaneous pneumothorax. Computed-tomography of the chest showed right-sided pneumothorax. At thoracoscopy, multiple fenestrations were revealed on the tendinous part of the right hemidiaphragm. They were resected and repaired for pathological studies. Microscopic findings revealed mesothelial cells lining around the fenestrations. No endometrial gland was found. We will describe and discuss the hypotheses of etiologies in our report. The treatment of catamenial pneumothorax is controversial, including surgery, tube thoracotomy, fallopian tube ligation and hormonal therapy. Surgical intervention together with hormonal therapy remains the most effective way and conforms to the principle of treatment.

手術を施行した月経随伴性気胸に対する検討

月経随伴性気胸は月経周期に一致して再発を繰り返す比較的稀な疾患であり, その治療方針はいまだ確立されていない.今回われわれは, この月経随伴性気胸に対して5例 (開胸手術3例, 小開胸併用胸腔鏡手術2例) の手術症例を経験したので, これをもとに月経随伴性気胸に対する治療方針について検討を加え報告する.5例は34～49歳の閉経前の女性で, いずれも右側の発症であった.5例中bullaは1例のみに認め, 横隔膜病変は全例に認められた.術後再発を5例中2例に認め (開胸手術1例, 小開胸併用手術1例), 1例は術後対側にも気胸を認めた.しかし, 患者の拒否により術後再発症例に対してもホルモン療法は施行しなかった.閉経前の女性が気胸を発症した場合には月経随伴性気胸の可能性を考えるべきである.また月経随伴性気胸は術後再発が多い疾患であることを考慮し慎重に治療方針を決定すべきであると思われた.

Successful conservative treatment of catamenial pneumothorax with GnRH agonist

Successful conservative treatment of catamenial pneumothorax with GnRH agonist