title: Primary Spontaneous Pneumothorax in Menstruating Women Has High Recurrence.
abstract: BACKGROUND
  Primary spontaneous pneumothorax (PSP) is treated on the basis of studies that have predominantly consisted of tall male subjects. Here, we determined recurrence of PSP in average-statured menstruating women and studied prevalence of catamenial pneumothorax (CP) in this population.
  
  
  METHODS
  Men and menstruating women, aged 18 to 55 years, without underlying lung disease or substance abuse were retrospectively studied between 2009 and 2015. A chest pathologist reviewed all specimens for thoracic endometriosis. Kaplan-Meier curves were constructed to determine recurrence.
  
  
  RESULTS
  The median age of women (n = 33) and men (n = 183) was 33.4 and 31.6 years, respectively. In women, 9 (27%) had left-sided and 24 (73%) had right-sided PSP, treated with tube thoracostomy. Recurrence occurred in 21 women (64%) with median follow-up of 14 months, and they were treated with thoracoscopic pleurodesis. Right PSP had higher recurrence (70%) than left PSP (56%, p = 0.02). Four women (12%) presented with recurrent tension pneumothorax within 6 months. Eight patients (24%) had PSP within 72 hours of menses, meeting clinical criteria of CP. All these were placed on hormonal suppression after initial episode but went on to experience recurrence that was treated with pleurodesis. Classical endometrial glands were not found in any biopsy specimens obtained during the thoracoscopy. In contrast to female subjects, only 8 average-statured men (4.4%) had recurrence (p < 0.001) with a median follow-up of 16 months.
  
  
  CONCLUSIONS
  PSP in healthy average-statured menstruating women has high recurrence compared with male counterparts. CP is a clinical diagnosis and often recurs despite hormonal suppression therapy.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Mehta
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Stanifer
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Susan
authors.initials: S
authors.lastname: Fore-Kosterski
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Colin
authors.initials: C
authors.lastname: Gillespie
authors.affiliation: Department of Pathology, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Anjana
authors.initials: A
authors.lastname: Yeldandi
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Shari
authors.initials: S
authors.lastname: Meyerson
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: David D
authors.initials: DD
authors.lastname: Odell
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Malcolm M
authors.initials: MM
authors.lastname: DeCamp
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois. Electronic address: abharat@nm.org.
authors.forename: Ankit
authors.initials: A
authors.lastname: Bharat
mesh_terms: D000328:Adult; D000367:Age Factors; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D018700:Pleurodesis / Q000379:methods*; D011030:Pneumothorax / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D055815:Young Adult