Catamenial pneumothorax (CP) is a rare type of pneumothorax and is characterised by recurrent accumulation of air in the thoracic space related to menstruation.
It may represent up to one-third of women with spontaneous pneumothoraces 1. Patient history may or may not be positive for previous endometriosis 10-11.
While the exact mechanism is not fully understood, it is generally thought to be related to endometrial deposits from endometriosis seeding through a diaphragmatic defect or fenestration (thoracic endometriosis).
On video-assisted thoracic surgery (VATS), diaphragmatic defects and nodules are often found, with pathology specimens also confirming endometriosis in most instances. Endometrial implants in visceral pleura are also found, although less frequently.
In general, no specific diagnostic imaging criteria exist. However, there is right side preponderance 7,10-11.
Imaging features are often identical to pneumothoraces from other causes. Rarely, small diaphragmatic defects may be encountered ("air bubbles"), representing small perforations of the diaphragm. These may also present as nodular appearance of the diaphragm. Cases of larger perforations presenting as basal thoracic opacities have also been described 7.
Might better depict above mentioned findings. An additional possible finding comprises partial intrathoracic herniation of the liver 7.
May suggest pleural based masses attributable to endometrial implants 7.
Treatment and prognosis
Most catamenial pneumothoraces are small and self resolving. Partial diaphragmatic resection and/or exeresis of visceral pleural implants, as well as talc pleurodesis, are sometimes carried out as part of treatment .
History and etymology
It was initially described in 1958 by Maurer 7, the term catamenial was coined by Lillington 9 in 1972. It is is derived from the Greek words - pertaining to and monthly 2,10.
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