Catamenial Pneumothorax and Endometriosis  

Catamenial Pneumothorax - What is it?
Spontaneous pneumothorax (SPT) is a well known condition among physicians. Air enters the pleural space around the lung, and causes the lung to collapse (1). What makes it spontaneous is that the collapse can occur without warning in a person who appears healthy. As Lynn's Pulmonary Specialist described it, "the lung collapses for no apparent reason". Medically, this may be due to the rupture of "blebs", which are blister-like appendages on the lung. Blebs and bullae are generally confirmed through surgery (1).   

SPT primarily affects tall thin men in their 20's and 30's (1). Women can also experience SPT, but statistically, it is rare. As such, it is not unreasonable to speculate that some women diagnosed with or treated for spontaneous pneumothorax, may actually have catamenial pneumothorax (CPT), which is not spontaneous at all! This is especially true for women who have had multiple collapses.

Catamenial pneumothorax is a rare condition characterized by a reoccurrence of air in the pleural space coinciding with the onset of menses (2). This condition was first described in literature in 1958 (3). It is almost always right-sided, and generally affects women in their 30's and 40's (4, 5).

Although the exact etiology of the condition is unknown, most physicians agree that endometriosis is involved (4). Documented case studies have described endometrial implants on the lung or pleura. This condition is described as thoracic or pulmonary endometriosis (6). More frequently however, articles describe cases involving diaphragmatic fenestrations (holes in the diaphragm)(1). Many researches attribute this damage to endometriosis and speculate that air passes into the pleural space through these holes (4, 6). Endometriosis is also thought responsible for corresponding hemothorax (blood in the pleural space) although this condition is more rare than pneumothorax (7).

Case studies report women with CPT experiencing monthly chest pain, shortness of breath, dizziness and fatigue. Some women have experienced multiple lung collapses over a period of several years. Many of these women have also been diagnosed with pelvic endometriosis (5).

Useful Links and References  (Information on spontaneous pneumothorax)

(1) Guidelines for the Diagnosis and Treatment of Spontaneous Pneumothorax. Rivas de Andres JJ, Jimenez Lopez MF, Lopez-Rodo LM, Perez Trullen A, Torres Lanzas J. J Arch Bronconeumol. 2008;44(8):437-48

(2) Thoracic Endometriosis: Current Knowledge. Alifano M, Trisolini R, Cancellieri A, Regnard JF. Ann Thorac Surg. 2006 Feb;81(2):761-9

(3) Chronic recurring spontaneous pneumothorax due to endometriosis of the diaphragm. Maurer ER, Schaal JA, Mendez FL. JAMA. 1958;168:2013-2014

(4) Catamenial Pneumothorax: Retrospective Study of Surgical Treatment. Bagan P, Barthes FL, Assouad J, Souilamas R, Riquet M. Ann Thorac Surg. 2003 Feb;75(2):378-381

(5) Recurrent Spontaneous Pneumothorax Associated with Menstrual Cycle: Report of Three Cases of Catamenial Pneumothorax. Choong CK, Smith MD, Haydock DA. ANZ J Surg. 2002 Sep;72(9):678-679

(6) Catamenial Pneumothorax Caused by Thoracic Endometriosis. Van Schil PE, Vercauteren SR, Vermeire PA, Nackaerts YH, Van Marck EA. Ann Thorac Surg. 1996 Aug;62(2):585-586

(7) Right-sided Hemothorax and Recurrent Abdominal Pain in a 34-Year-Old Woman. Shepard MK, Mancini MC, Campbell GD, George R. Chest. 1993 Apr;103(4):1239-1240

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