title: Gynecologic evaluation of catamenial pneumothorax associated with endometriosis.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan. kumakiri@juntendo.ac.jp
authors.forename: Jun
authors.initials: J
authors.lastname: Kumakiri
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kumakiri
authors.forename: Hideaki
authors.initials: H
authors.lastname: Miyamoto
authors.forename: Iwaho
authors.initials: I
authors.lastname: Kikuchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Arakawa
authors.forename: Mari
authors.initials: M
authors.lastname: Kitade
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeda
mesh_terms: 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