Catamenial pneumothorax: optimal hormonal and surgical management.
OBJECTIVE
To provide further information addressing the etiology, optimal hormonal management and surgical management in catamenial pneumothorax (CP).


METHODS
We retrospectively analyzed records of all female patients operated on for spontaneous pneumothorax at a university hospital between January 1993 and March 2002.


RESULTS
In eight of 24 patients, pneumothoraces were timed with menses. In all, the right side was involved. Seven patients were on hormonal medications pre-operatively and six post-operatively. All six patients taking estrogen/progesterone replacement had recurrences pre-operatively and two of three had recurrences post-operatively while on these medications. No patient suffered a pneumothorax either pre- or post-operatively while taking a gonadotropin releasing hormone agonist (two and three patients, respectively). Intraoperative findings included diaphragmatic implants [5] diaphragmatic fenestrations [4], apical blebs [2] and visceral pleural implants [2]. All pathology was specifically addressed at the time of surgery. Pleural space management included mechanical pleurodesis in seven and pleurectomy with talc insufflation in 1. Follow-up ranged from 27 to 63 months with a mean of 48 months. Three patients developed post-operative recurrences. One was managed without intervention and two required additional procedures.


CONCLUSIONS
Catamenial pneumothorax is under appreciated, representing up to one-third of women with spontaneous pneumothorax. Hormonal agents that allow for menses are ineffective. Gonadotropin releasing hormone agonists should be considered as part of the pre-operative or post-operative management in high risk patients. Our findings suggest that an additional intervention to augment pleural symphysis at the level of the diaphragm should be performed.
Marshall
M Blair
MB
Section of General Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. mbm5@gunet.georgetown.edu
Ahmed
Zahoor
Z
Kucharczuk
John C
JC
Kaiser
Larry R
LR
Shrager
Joseph B
JB
D000328:Adult; D004715:Endometriosis / Q000150:complications / Q000601:surgery; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D008598:Menstruation; D011030:Pneumothorax / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods
D007987:Gonadotropin-Releasing Hormone