Catamenial pneumothorax: A scourge not to be ignored
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Catamenial pneumothorax, linked to thoracic endometriosis, is diagnosed via imaging and thoracoscopy and effectively treated with hormonal and surgical interventions.
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Abstract
Catamenial pneumothorax (CP) is defined as spontaneous pneumothorax occurring within 72 h before or after the onset of menstruation. It is the most common form of thoracic endometriosis syndrome (TES), which includes catamenial hemoptysis, catamenial hemothorax, catamenial hemopneumothorax, and endometrial nodular lung mass. The purported pathogeneses are the retrograde menstruation and implantation of endometrial tissue in the thoracic cavity, the entry of endometrial cells into the venous system and metastatic spread of endometrial tissue, the coelomic metaplasia and the effect of the potent prostaglandin F2 causing the rupture of subpleural blebs at peak of menstruation. This condition was considered a rare entity even in our local setting; however, a prospective study about a decade ago showed that 25% of women hospitalized in an 18-month period for surgical treatment of spontaneous pneumothorax had this condition. The diagnosis is established by clinical evaluation with chest computerized tomography scan and video-assisted thoracoscopy, and immediate multimodality treatment using hormonal and surgical interventions will substantially reduce morbidity and mortality.
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