Catamenial pneumothorax: Difference between revisions

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==Clinical Features==
==Clinical Features==
*[[Spontaneous pneumothorax]] symptoms <72 hours after menstruation
*[[Spontaneous pneumothorax]] symptoms <72 hours after menstruation
**[[SOB]], [[chest pain]], tachypnea, [[hypoxia]]
*Exclusively in women of menstrual age (typically 30–40 years old)
*Exclusively in women of menstrual age (typically 30–40 years old)
*History of endometriosis
*History of [[endometriosis]]


==Differential Diagnosis==
==Differential Diagnosis==
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==Evaluation==
==Evaluation==
{{Pneumothorax diagnosis}}
{{Pneumothorax diagnosis}}
{{Lung ultrasound pneumothorax}}


==Management==
==Management==
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===Unstable===
===Unstable===
*[[Needle decompresion]] followed by [[chest tube]] insertion
*[[Needle decompression]] followed by [[chest tube]] insertion


===Stable===
===Stable===
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==Disposition==
==Disposition==
*Admission
*Admission
==Complications==
*[[Reexpansion pulmonary edema]]


==See Also==
==See Also==

Latest revision as of 15:00, 12 October 2019

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

Differential Diagnosis

Pneumothorax Types

Evaluation

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

Pneumothorax.jpeg
  • 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

Lung ultrasound of pneumothorax

  • No lung sliding seen (not specific for pneumothorax)
  • May also identify "lung point": distinct point where you no longer see lung sliding (pathognomonic)
  • Absence of lung sliding WITHOUT lung point could represent apnea or right mainstem intubation
  • Evaluate other intercostal spaces because pneumothorax may only be seen in least dependent area of thorax
    • NO comet tail artifact
    • Bar Code appearance/"Stratosphere" sign on M-mode (absence of "seashore" waves)
  • Ultrasound has greater sensitivity than chest x-ray for pneumothorax in trauma patients [3]

Management

Supplemental oxygen (non-rebreather mask) initially for all

Unstable

Stable

Adult Chest Tube Sizes

Chest Tube Size Type of Patient Underlying Causes
Small (8-14 Fr)
  • Alveolar-pleural fistulae (small air leak)
  • Iatrogenic air
Medium (20-28 Fr)
  • Trauma/bleeding (hemothorax/hemopneumothorax)
  • Bronchial-pleural fistulae (large air leak)
  • Malignant fluid
Large (36-40 Fr)
  • Thick pus

Disposition

  • Admission

Complications

See Also

External Links

References

  1. 1.0 1.1 1.2 1.3 NV Aikaterini, et al. "Catamenial pneumothorax: a rare entity? Report of 5 cases and review of the literature." Journal of Thoracic Disease. Vol 4, Supplement 1 (November 2012)
  2. Eur Respir J. 1996 Mar;9(3):406-9
  3. Nagarsheth K, Kurek S. Ultrasound detection of pneumothorax compared with chest X-ray and computed tomography scan. Am Surg. 2011 Apr;77(4):480-4. PMID: 21679560.
  4. Inaba Et. al J Trauma Acute Care Surg. 2012 Feb;72(2):422-7.
  5. Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.