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Catamenial and Noncatamenial, Endometriosis-related or Nonendometriosis-related Pneumothorax Referred for Surgery

¹ Department of Thoracic Surgery, Hôtel-Dieu Hospital, Paris V University, Paris, France; ² JE2492, Paris Sud University, Paris, France; and ³ Department of Medical Gynecology and ⁴ Department of Pathology, Hôtel-Dieu Hospital, Paris V University, Paris, France

Correspondence and requests for reprints should be addressed to Marco Alifano, M.D., Unité de Chirurgie Thoracique, Hôtel-Dieu, 1, Place du Parvis Notre-Dame, 75181 Paris, France. E-mail: marcoalifano{at}yahoo.com

Rationale: Catamenial and endometriosis-related pneumothorax are considered relatively rare entities. Their clinical characteristics and outcome are incompletely known.

Objectives: To evaluate the frequencies, clinical characteristics, and outcomes of catamenial and endometriosis-related pneumothoraces occurring in women with no underlying lung disease referred for surgical treatment.

Methods: Clinical files of all the women of reproductive age referred to our center during a 6-year period for surgical treatment of spontaneous pneumothorax were retrospectively reviewed. Catamenial pneumothorax (CP) was defined as recurrent pneumothorax occurring between the day before and within 72 hours after the onset of menses. All histologic slides were reviewed to confirm initial diagnoses.

Measurements and Main Results: A total of 114 women underwent video-assisted thoracic surgery; 28 women (24.6%) had CP (right-sided in all but one), and diaphragmatic abnormalities (perforations and/or nodules) were observed in 22 of them. Diaphragmatic abnormalities were seen in 21 of 86 patients with non-CP. Histologic examination found endometriosis, mainly diaphragmatic, in 18 of 28 CPs and 11 of 86 non-CPs. A 6-month antigonadotropic treatment was prescribed postoperatively to women with either CP or endometriosis-related pneumothorax. Mean follow-up was 32.7 (±18.5) months. Recurrence rates in CP, non-CP but endometriosis-related, and non-CP non–endometriosis-related pneumothoraces were 32, 27, and 5.3%, respectively.

Conclusions: Our experience shows that (1) CP and/or endometriosis-related pneumothoraces account for an important percentage of spontaneous pneumothoraces referred for surgery, (2) diaphragmatic abnormalities seem to play a fundamental role in their pathogenesis, and (3) management is difficult because of the high recurrence rate.

Key Words: catamenial • endometriosis • pathology • pneumothorax • surgery

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Catamenial pneumothorax (CP) is considered a relatively rare entity. Endometriosis is found in a variable percentage of cases. Endometriosis-related pneumothoraces are thought to occur only in the menstrual period. Little is known on long-term outcome. What This Study Adds to the Field Pneumothorax in women has frequently a catamenial character and thoracic endometriosis is often found. Recurrence rate is relatively high.