Catamenial pneumothorax

Background

• Definition: Spontaneous, recurrent pneumothorax in women of reproductive age, occurring in temporal relationship with menses
• Caused by endometriosis of the pleura
• 3-6% of pneumothoraxes in women
• A form of thoracic endometriosis syndrome

Clinical Features

• Spontaneous pneumothorax symptoms <72 hours after menstruation
• Exclusively in women of menstrual age (typically 30–40 years)
• History of endometriosis

Differential Diagnosis

Pneumothorax Types

The pleural cavity is normally a potential space, in which air collects in a pneumothorax.

• Tension pneumothorax
• Spontaneous pneumothorax
  • Catamenial pneumothorax
• Traumatic pneumothorax
  • Iatrogenic pneumothorax

Diagnosis

Clinically Stable

Defined as having all of the following:

• Resp rate < 24
• Heart rate 60-120 beats per minute
• Normal BP
• SaO2 >90% on room air and patient can speak in whole sentences

Workup

• CXR
  • Displaced visceral pleural line without lung markings between pleural line and chest wall
  • Upright is best
    • Expiratory films DO NOT improve accuracy
    • Lateral decubitus films with suspected side up do increase sensitivity. Good approach in pediatrics to avoid CT
  • Supine CXR = deep sulcus sign
• CT Chest
  • Very sensitive and specific

Management

Unstable

• Needle decompresion followed by chest tube insertion

Stable

• Tube thoracostomy
• Surgery and hormonal treatment

Disposition

• Admission

See Also

• Pneumothorax (main)