title: Catamenial pneumothorax: retrospective study of surgical treatment.
abstract: BACKGROUND
  Catamenial pneumothorax is a rare entity characterized by recurrent accumulation of air in the thoracic space during menstruation. Catamenial pneumothorax is also associated with a high rate of postoperative recurrence. The aim of this study was to discuss the etiology and to determine the optimal surgical treatment of this entity.
  
  
  METHODS
  From December 1991 to September 2000, 10 patients with catamenial pneumothorax were treated at our institution. Median age at time of operation was 37 years (range, 21 to 44 years). We retrospectively evaluated the pathologic findings, the operation performed, and the results in all patients. The mean follow-up was 55.7 months.
  
  
  RESULTS
  Pleurodesis alone was performed in 5 patients and an associated diaphragmatic procedure was performed in 5 patients. In 5 patients, no diaphragmatic anomaly was discovered: 3 experienced one or more recurrences and all still suffer from chronic catamenial chest pain. Hormonal therapy temporarily improved outcome for 6 months in 2 patients. On the contrary, in 5 patients surgical pleurodesis was associated with the repair of diaphragmatic defects (simple closure or coverage by a polyglactin mesh): these patients experienced no recurrence (n = 0/5, p = 0.0016) and no subsequent catamenial chest pain.
  
  
  CONCLUSIONS
  The postoperative outcome is influenced by the diagnosis of diaphragmatic defects with or without endometriosis. Surgical treatment should be accomplished during menstruation for an optimal visualization of pleurodiaphragmatic endometriosis. Because diaphragmatic lesion is frequent and may be occult, we propose the systematic coverage of the diaphragmatic surface by a polyglactin mesh to prevent catamenial pneumothorax recurrence even when the diaphragm appears normal.
authors.affiliation: Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bagan
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Pimpec Barthes
authors.forename: Jalal
authors.initials: J
authors.lastname: Assouad
authors.forename: Redha
authors.initials: R
authors.lastname: Souilamas
authors.forename: Marc
authors.initials: M
authors.lastname: Riquet
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008598:Menstruation; D011030:Pneumothorax / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh