Current Therapy of Catamenial Pneumothorax

(#1998-21980 ... October 8, 1998)

LTC Henry F. Tripp, MD, Capt. Linda P. Thomas, MD, Capt. James A. Obney, MD

Department of Cardiothoracic Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas

ABSTRACT

Catamenial pneumothorax, or monthly recurring pneumothorax associated with menstruation, has been reported with increasing frequency in recent years. A representative case illustrates the clinical syndrome, particularly the intraoperative findings. Characteristic of this disorder are a peak incidence in the late twenties or early thirties, recurrent right-sided pneumothoraces occurring at the onset of menstruation, and an association with pelvic endometriosis. Pathologically, there is a consistent pattern of intrathoracic, especially diaphragmatic, foci of ectopic endometrial tissue. There is also a strong association with diaphragmatic fenestrations, though their significance is controversial. Traditional therapy has involved treatment with estrogens, danazol, or thoracotomy with mechanical pleurodesis. These methods have proven, through a large meta-analysis, to be associated with a relatively high rate of recurrence. Subsequent advances in hormonal therapy, along with the development of minimal access surgery, have led to an evolution in management. Despite uncertainty as to the etiology of catamenial pneumothorax, diagnosis of the condition is straightforward and modern treatment is successful in preventing recurrence.

AUTHOR/ARTICLE INFORMATION

Reprint Requests to: LTC Henry F. Tripp, USAF, MD, Brooke Army Medical Center, Cardiothoracic Surgery Service, MHCE-SDC, Bldg. 3600, 3851 Roger Brooke Dr., Fort Sam Houston, TX 78234-6200. HtrippMD@aol.com

Submitted on: October 8, 1998

Keywords: Catamenial pneumothorax, thoracic endometriosis, video-assisted thoracoscopic surgery (VATS), gonadotropin releasing hormone (Gn-RH) analogue