Catamenial pneumothorax: Difference between revisions
| Line 17: | Line 17: | ||
==Management== | ==Management== | ||
''[[Supplemental oxygen]] ([[non-rebreather mask]]) initially for all'' | |||
===Unstable=== | ===Unstable=== | ||
*[[Needle decompresion]] followed by [[chest tube]] insertion | *[[Needle decompresion]] followed by [[chest tube]] insertion | ||
Revision as of 22:07, 13 May 2015
Background
- Definition: Spontaneous, recurrent pneumothorax in women of reproductive age, occurring in temporal relationship with menses[1]
- Caused by endometriosis of the pleura[1]
- 3-6% of pneumothoraxes in women[1]
- 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
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[2]
- 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
Supplemental oxygen (non-rebreather mask) initially for all
Unstable
- Needle decompresion followed by chest tube insertion
Stable
- Tube thoracostomy
- Surgery and hormonal treatment[1]
Disposition
- Admission