Catamenial pneumothorax

From WikEM
Jump to: navigation, search


  • 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 old)
  • History of endometriosis

Differential Diagnosis

Pneumothorax Types


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


  • CXR
    • Displaced visceral pleural line without lung markings between pleural line and chest wall
    • Upright is best
      • Expiratory films DO NOT improve accuracy[2]
    • Supine CXR = deep sulcus sign
  • CT Chest
    • Very sensitive and specific
  • Ultrasound
    • NO comet tail artifact
    • No sliding lung sign
    • Bar Code appearance on M-mode (absence of "seashore" waves)


Supplemental oxygen (non-rebreather mask) initially for all



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)
  • Bronchial-pleural fistulae (large air leak)
  • Malignant fluid
Large (36-40 Fr)
  • Bleeding (Hemothorax/hemopneumothorax)
  • Thick pus


  • Admission

See Also

External Links


  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