Catamenial pneumothorax

Case contributed by Matthew Hung

Presentation

30-year-old female with history of asthma and recurrent pneumothorax presenting with worsening shortness of breath and right pleuritic chest pain.

Patient Data

Age: 30 years old
Gender: Female
X-ray

Chest X-ray on presentation

Diffuse lucency surrounding the right lung is consistent with a moderate-sized pneumothorax. Right perihilar linear densities likely represent atelectasis/scarring. The left lung is clear.

CT

Preoperative CT Chest

Residual small right apical pneumothorax s/p placement of pleural space catheter. Linear scar is seen at the right lung apex. Mild bibasilar, right greater than left, densities, most likely subsegmental atelectasis on this noncontrast exam. No subpleural blebs are visualized.

X-ray

Postoperative follow-up Chest X-ray

Linear density likely representing fibrosis/scarring in the right upper zone. Surgical sutures in the right upper zone and right lower zone adjoining the right hemidiaphragm are present and are in keeping with s/p right upper lobe wedge resection and right partial diaphragmatic excision. No evidence of recurrent pneumothorax.

Pathology

Surgical Pathology

Surgical specimens demonstrate endometrial glands and stroma on H&E. The immunohistochemical stain demonstrates CD10 positivity, in keeping with endometrial stromal elements. These findings are consistent with thoracic endometriosis.

Case Discussion

The patient elected for surgery to decrease risk of recurrent pneumothorax. A right VATS, right upper lobe wedge resection, right partial diaphragmatic excision, chemical (doxycycline) and mechanical pleurodesis were performed. Intraoperatively, the patient was noted to have chocolate-colored nodules of the parietal pleura, and right hemidiaphragm, and scarring of the apical segment of the right upper lobe. These specimens were sent to pathology, and presence of thoracic endometriosis was confirmed on histology. The patient was discharged with oral contraceptive pills.

This case was submitted with supervision and input from:

Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center    

Pathology slides and input were provided by:

Corina Kwan, M.D.
Department of Pathology
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center    

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Case information

rID: 54382
Case created: 7th Jul 2017
Last edited: 12th Jul 2017
Systems: Chest, Gynaecology
Inclusion in quiz mode: Included

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