{{Short description|A rare form of pneumothorax associated with menstruation}}
| name = Catamenial pneumothorax
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| field = pulmonology
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'''Catamenial pneumothorax''' is a condition of [[pneumothorax|air leaking into the pleural space]] (pneumothorax) occurring in conjunction with [[menstrual periods]] (''catamenial'' refers to [[menstruation]]), and or during ovulation, believed to be caused primarily by [[endometriosis]] of the [[pleura]] (the membrane surrounding the [[lung]] or diaphragm).<ref name=mercksource>{{Cite web |url=http://www.mercksource.com/pp/us/cns/cns_hl_dorlands.jspzQzpgzEzzSzppdocszSzuszSzcommonzSzdorlandszSzdorlandzSzdmd_p_25zPzhtm#12652312 |title=Definition from mercksource.com (Dorlands Medical Dictionary) |access-date=2006-07-01 |archive-url=https://web.archive.org/web/20060702190555/http://www.mercksource.com/pp/us/cns/cns_hl_dorlands.jspzQzpgzEzzSzppdocszSzuszSzcommonzSzdorlandszSzdorlandzSzdmd_p_25zPzhtm#12652312 |archive-date=2006-07-02 |url-status=dead }}</ref>
==Signs and symptoms==
'''Catamenial pneumothorax''' is a rare condition characterized by the occurrence of [[pneumothorax]] in conjunction with the [[menstrual cycle]]. It is considered a form of [[thoracic endometriosis syndrome]], where endometrial tissue is present in the thoracic cavity.
Onset of lung collapse is less than 72 hours after menstruation. Typically, it occurs in women aged 30 to 40 years, but it has been diagnosed in young girls as early as 10 years of age and post menopausal women (exclusively in women of [[Menarche|menstrual age]]), most with a history of [[pelvis|pelvic]] [[endometriosis]].
==Pathophysiology==
==Pathophysiology==
[[endometrium|Endometrial tissue]] attaches within the [[thoracic cavity]], forming chocolate-like [[cyst]]s. Generally the [[parietal pleura]] is involved, but the lung itself, the [[visceral pleura|visceral layer]], the [[Thoracic diaphragm|diaphragm]], and more rarely the [[tracheobronchial tree]] may also be afflicted.<ref name=AmJMed>{{cite journal | author = Joseph J, Sahn SA | year = 1996 | title = Thoracic endometriosis syndrome: new observations from an analysis of 110 cases | url = | journal = Am J Med | volume = 100 | issue = 2| pages = 164–70 | pmid = 8629650 | doi = 10.1016/s0002-9343(97)89454-5 }}</ref> The mechanism through which [[endometrium|endometrial tissue]] reaches the thorax remains unclear. Defects in the diaphragm, which are found often in affected individuals, could provide an entry path,<ref name=chest>{{cite journal | author = Alifano M, Roth T, Broet SC, Schussler O, Magdeleinat P, Regnard JF | year = 2003 | title = Catamenial pneumothorax: a prospective study | url = | journal = Chest | volume = 124 | issue = 3| pages = 1004–8 | pmid = 12970030 | doi = 10.1378/chest.124.3.1004 }}</ref> as could microembolization through pelvic veins.<ref>{{cite journal | author = Peikert T, Gillespie DJ, Cassivi SD | year = 2005 | title = Catamenial pneumothorax | url = | journal = Mayo Clin Proc | volume = 80 | issue = | pages = 677–80 | doi = 10.4065/80.5.677 }}</ref>
Catamenial pneumothorax is believed to be caused by the presence of [[endometrial tissue]] in the thoracic cavity, which can lead to the formation of air leaks during menstruation. The exact mechanism is not fully understood, but several theories have been proposed:
The cysts can release [[blood]]; the endometrial cyst "menstruates" in the lung. Air can move in by an unknown mechanism. The blood and air cause the lung to collapse (''i.e.'' catamenial [[hemopneumothorax]]).<ref>^ a b Glynis D. Wallace. Living With Lung And Colon Endometriosis: Catamenial Pneumothorax. Authorhouse, 2005. {{ISBN|1-4208-8331-3}}</ref>
* '''Diaphragmatic defects''': Small holes or fenestrations in the [[diaphragm]] may allow air to pass from the abdominal cavity into the pleural space.
* '''Hormonal influence''': The cyclical nature of the condition suggests a hormonal component, possibly related to the effects of [[estrogen]] and [[progesterone]].
* '''Microembolization''': Endometrial tissue may travel through the bloodstream and implant in the thoracic cavity.
==Clinical Presentation==
Patients with catamenial pneumothorax typically present with symptoms of pneumothorax, such as sudden onset of [[chest pain]] and [[dyspnea]], occurring within 72 hours of the onset of menstruation. The right side of the chest is more commonly affected.
==Diagnosis==
==Diagnosis==
[[Diagnosis]] can be hinted by high recurrence rates of lung collapse in a woman of reproductive age with endometriosis. [[CA-125]] is elevated. Video-assisted [[thoracoscopy]] is used for confirmation.
The diagnosis of catamenial pneumothorax is based on the correlation of pneumothorax episodes with the menstrual cycle. Imaging studies, such as a [[chest X-ray]] or [[CT scan]], can confirm the presence of pneumothorax.
===Classification===
[[File:Pneumothorax_CXR.jpg|thumb|right|Chest X-ray showing a pneumothorax]]
Catamenial pneumothorax is the most common form of [[thoracic endometriosis syndrome]], which also includes [[catamenial hemothorax]], [[catamenial hemoptysis]], [[catamenial hemopneumothorax]] and [[endometriosis]] lung [[Nodule (medicine)|nodule]]s, as well as some exceptional presentations.<ref name=Bricelj>{{cite journal | author = Bricelj K | display-authors = etal | year = 2017 | title = A systematic review | url = | journal = Wien Klin Wochenschr | volume = 129 | issue =19–20 | pages = 717–726 | doi = 10.1007/s00508-017-1237-4 | pmid = 28762057 }}</ref>
==Treatment==
==Treatment==
[[Pneumothorax]] can be a [[medical emergency]], as it can become associated with decreased lung function, and if progressed to [[tension pneumothorax]], potentially fatal. In many cases, catamenial pneumothorax will resolve spontaneously and not require immediate intervention. In more severe cases, a [[chest tube]] may be required to release air and/or blood and to allow the lung to re-expand.
Treatment options for catamenial pneumothorax include:
Surgery, hormonal treatments and combined approaches have all been proposed, with variable results in terms of short and long term outcome.<ref name=Peikert_2005>{{cite journal |vauthors=Peikert T, Gillespie DJ, Cassivi SD |title=Catamenial pneumothorax: case report and review of the literature |journal=Mayo Clinic Proceedings |volume=80 |issue=5 |pages=677–680 |year=2005 |pmid=15887438 |doi=10.4065/80.5.677|doi-access=free }}</ref> Surgical removal of the endometrial tissue should be endeavoured during menstruation for optimal visualisation of the cyst.<ref name=asian>{{cite journal | author = Poyraz AS, Kilic D, Hatipoglu A, Demirhan BA | year = 2005 | title = A very rare entity: catamenial pneumothorax | url = | journal = Asian Cardiovasc Thorac Ann | volume = 13 | issue = 3| pages = 271–3 | pmid = 16113003 | doi = 10.1177/021849230501300317 }}</ref> [[Pleurodesis]] may also be helpful. Menstruation and accompanying lung collapse can be suppressed with hormone therapy,<ref name=eMedicine>{{eMedicine|radio|563}}</ref> like with [[Leuprolide|Lupron Depot]], [[danazol]] or [[extended cycle combined oral contraceptive pill]]s, or GnRH antagonist medications.
==Epidemiology==
* '''Surgical intervention''': Procedures such as [[video-assisted thoracoscopic surgery]] (VATS) can be used to repair diaphragmatic defects and remove ectopic endometrial tissue.
Some sources claim this entity represents 3 to 6% of pneumothorax in women.<ref name="eMedicine" /> In regard of the low [[incidence (epidemiology)|incidence]] of primary spontaneous pneumothorax (''i.e.'' not due to surgical trauma ''etc.'') in women (about 1/100'000/year),<ref name="eMedicine" /> this is a very rare condition. Hence, many basic textbooks do not mention it, and many [[Physician|doctors]] have never heard of it. Therefore, catamenial pneumothorax is probably under-recognized.<ref name="chest"/>
* '''Hormonal therapy''': Medications that suppress ovulation, such as [[gonadotropin-releasing hormone]] (GnRH) analogs, can be effective in preventing recurrence.
* '''Pleurodesis''': A procedure to obliterate the pleural space and prevent recurrent pneumothorax.
==References==
==Prognosis==
{{Reflist}}
With appropriate treatment, the prognosis for catamenial pneumothorax is generally good. However, recurrence is possible, and long-term management may be necessary.
== External links ==
==Related pages==
{{Medical resources
* [[Pneumothorax]]
| ICD10 = <!--{{ICD10|Xxx.x}}-->
* [[Endometriosis]]
| ICD9 = <!--{{ICD9|xxx}}-->
* [[Thoracic endometriosis syndrome]]
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| OMIM = 131200
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{{Respiratory pathology}}
{{DEFAULTSORT:Catamenial Pneumothorax}}
[[Category:Respiratory diseases]]
[[Category:Medical emergencies]]
[[Category:Gynecological disorders]]
[[Category:Menstrual disorders]]
[[Category:Diseases of pleura]]
[[Category:Rare diseases]]
{{dictionary-stub1}}
Revision as of 05:38, 16 February 2025
A rare form of pneumothorax associated with menstruation
Catamenial pneumothorax is a rare condition characterized by the occurrence of pneumothorax in conjunction with the menstrual cycle. It is considered a form of thoracic endometriosis syndrome, where endometrial tissue is present in the thoracic cavity.
Catamenial pneumothorax is believed to be caused by the presence of endometrial tissue in the thoracic cavity, which can lead to the formation of air leaks during menstruation. The exact mechanism is not fully understood, but several theories have been proposed:
Diaphragmatic defects: Small holes or fenestrations in the diaphragm may allow air to pass from the abdominal cavity into the pleural space.
Hormonal influence: The cyclical nature of the condition suggests a hormonal component, possibly related to the effects of estrogen and progesterone.
Microembolization: Endometrial tissue may travel through the bloodstream and implant in the thoracic cavity.
Clinical Presentation
Patients with catamenial pneumothorax typically present with symptoms of pneumothorax, such as sudden onset of chest pain and dyspnea, occurring within 72 hours of the onset of menstruation. The right side of the chest is more commonly affected.
Diagnosis
The diagnosis of catamenial pneumothorax is based on the correlation of pneumothorax episodes with the menstrual cycle. Imaging studies, such as a chest X-ray or CT scan, can confirm the presence of pneumothorax.
Chest X-ray showing a pneumothorax
Treatment
Treatment options for catamenial pneumothorax include:
Surgical intervention: Procedures such as video-assisted thoracoscopic surgery (VATS) can be used to repair diaphragmatic defects and remove ectopic endometrial tissue.
Hormonal therapy: Medications that suppress ovulation, such as gonadotropin-releasing hormone (GnRH) analogs, can be effective in preventing recurrence.
Pleurodesis: A procedure to obliterate the pleural space and prevent recurrent pneumothorax.
Prognosis
With appropriate treatment, the prognosis for catamenial pneumothorax is generally good. However, recurrence is possible, and long-term management may be necessary.
