Catamenial pneumothorax
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
- SOB, chest pain, tachypnea, hypoxia
- Exclusively in women of menstrual age (typically 30–40 years old)
- History of endometriosis
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
- 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
- Needle decompression followed by chest tube insertion
Stable
- Tube thoracostomy
- Surgery and hormonal treatment[1]
Adult Chest Tube Sizes
| Chest Tube Size | Type of Patient | Underlying Causes |
| Small (8-14 Fr) |
|
|
| Medium (20-28 Fr) |
|
|
| Large (36-40 Fr) |
|
Disposition
- Admission
Complications
See Also
External Links
References
- ↑ 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)
- ↑ Eur Respir J. 1996 Mar;9(3):406-9
- ↑ 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.
- ↑ Inaba Et. al J Trauma Acute Care Surg. 2012 Feb;72(2):422-7.
- ↑ Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.