Gynecologic evaluation of catamenial pneumothorax associated with endometriosis.
OBJECTIVE
To assess the pathogenesis of catamenial pneumothorax associated with endometriosis from a gynecologic perspective.


METHODS
Retrospective study (Canadian Task Force classification II-2).


METHODS
University hospital.


METHODS
Eleven patients with clinically suspected catamenial pneumothorax due to frequently recurrent pneumothorax who underwent thoracoscopy between September 2003 and February 2007 at our hospital.


METHODS
Video-assisted thoracoscopy.


RESULTS
Episodes of pneumothorax, coexistence of intrapelvic endometriosis, classification of intrathoracic lesions according to the appearance of pelvic endometriosis using the revised American Society of Reproductive Medicine (re-ASRM) classification, and histopathologic findings in intrathoracic specimens were assessed. A total of 38 episodes of pneumothorax, all on the right side, were documented in 11 patients with catamenial pneumothorax. Median (range) patient age at the initial pneumothorax was 42 (29-47) years. The re-ASRM score in 6 patients in whom pelvic endometriosis was directly observed at laparoscopy and laparotomy was 56 (18-96). We postoperatively reviewed videotape recordings of video-assisted thoracoscopy, and observed superficial thoracic diaphragmatic lesions classified as red (n = 5), black (n = 8), and white (n = 9) with fenestration according to the re-ASRM classifications for pelvic endometriosis. Tissue associated with endometriosis was detected at histopathologic analysis of resected diaphragmatic lesions in 9 patients. No endometriosis was identified at histopathologic analysis of visceral pleural lesions in 7 patients who underwent lung resection.


CONCLUSIONS
Gynecologic evaluation of catamenial pneumothorax associated with endometriosis is crucial to clarify the unelucidated pathogenesis of the disease.
Kumakiri
Jun
J
Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan. kumakiri@juntendo.ac.jp
Kumakiri
Yuko
Y
Miyamoto
Hideaki
H
Kikuchi
Iwaho
I
Arakawa
Atsushi
A
Kitade
Mari
M
Takeda
Satoru
S
D000328:Adult; D004715:Endometriosis / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008598:Menstruation; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted