Catamenial and noncatamenial, endometriosis-related or nonendometriosis-related pneumothorax referred for surgery.
BACKGROUND
Catamenial and endometriosis-related pneumothorax are considered relatively rare entities. Their clinical characteristics and outcome are incompletely known.


OBJECTIVE
To evaluate the frequencies, clinical characteristics, and outcomes of catamenial and endometriosis-related pneumothoraces occurring in women with no underlying lung disease referred for surgical treatment.


METHODS
Clinical files of all the women of reproductive age referred to our center during a 6-year period for surgical treatment of spontaneous pneumothorax were retrospectively reviewed. Catamenial pneumothorax (CP) was defined as recurrent pneumothorax occurring between the day before and within 72 hours after the onset of menses. All histologic slides were reviewed to confirm initial diagnoses.


RESULTS
A total of 114 women underwent video-assisted thoracic surgery; 28 women (24.6%) had CP (right-sided in all but one), and diaphragmatic abnormalities (perforations and/or nodules) were observed in 22 of them. Diaphragmatic abnormalities were seen in 21 of 86 patients with non-CP. Histologic examination found endometriosis, mainly diaphragmatic, in 18 of 28 CPs and 11 of 86 non-CPs. A 6-month antigonadotropic treatment was prescribed postoperatively to women with either CP or endometriosis-related pneumothorax. Mean follow-up was 32.7 (+/-18.5) months. Recurrence rates in CP, non-CP but endometriosis-related, and non-CP non-endometriosis-related pneumothoraces were 32, 27, and 5.3%, respectively.


CONCLUSIONS
Our experience shows that (1) CP and/or endometriosis-related pneumothoraces account for an important percentage of spontaneous pneumothoraces referred for surgery, (2) diaphragmatic abnormalities seem to play a fundamental role in their pathogenesis, and (3) management is difficult because of the high recurrence rate.
Alifano
Marco
M
Department of Thoracic Surgery, Hôtel-Dieu Hospital, Paris V University, Paris, France. marcoalifano@yahoo.com
Jablonski
Christine
C
Kadiri
Habiba
H
Falcoz
Pierre
P
Gompel
Anne
A
Camilleri-Broet
Sophie
S
Regnard
Jean-François
JF
D000293:Adolescent; D000328:Adult; D004715:Endometriosis / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008598:Menstruation; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013896:Thoracic Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome