1/14. Catamenial pneumothorax caused by diaphragmatic stromal endometriosis.A case of catamenial pneumothorax caused by stromal endometriosis of the diaphragm is described. A 40-year-old woman suffered two episodes of right-sided pneumothorax which occurred after onset of menstruation. thoracoscopy revealed brownish spots in the right diaphragm and partial excision of the diaphragm was performed. Histological examination showed that the lesion was characterized by sheets of cells resembling endometrial stromal cells, small thin-walled blood vessels and extravasated erythrocytes in varying proportions. Some clusters of these cells were transmural. No endometrial-type glands were found. Immunohistochemically, the nuclei of the endometrial stromal cells were strongly positive for both estrogen and progesterone receptors. Therapy with a gonadotropin-releasing hormone analogue was started and the patient has since been asymptomatic for 6 months. Pathologists should not overlook diaphragmatic stromal endometriosis as a possible cause of pneumothorax.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
2/14. Visualization of diaphragmatic fenestration associated with catamenial pneumothorax.Catamenial pneumothorax is a rare entity of unknown etiology characterized by recurrent accumulation of air in the thoracic space during or preceding menstruation. We documented the presence of a diaphragmatic fenestration during thoracoscopy, lending support for hypotheses involving diaphragmatic defects as possible avenues of air collection in the thorax.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
3/14. Current therapy of catamenial pneumothorax.Catamenial pneumothorax, or monthly recurring pneumothorax associated with menstruation, has been reported with increasing frequency in recent years. A representative case illustrates the clinical syndrome, particularly the intraoperative findings. Characteristic of this disorder are a peak incidence in the late twenties or early thirties, recurrent right-sided pneumothoraces occurring at the onset of menstruation, and an association with pelvic endometriosis. Pathologically, there is a consistent pattern of intrathoracic, especially diaphragmatic, foci of ectopic endometrial tissue. There is also a strong association with diaphragmatic fenestrations, though their significance is controversial. Traditional therapy has involved treatment with estrogens, danazol, or thoracotomy with mechanical pleurodesis. These methods have proven, through a large meta-analysis, to be associated with a relatively high rate of recurrence. Subsequent advances in hormonal therapy, along with the development of minimal access surgery, have led to an evolution in management. Despite uncertainty as to the etiology of catamenial pneumothorax, diagnosis of the condition is straightforward and modern treatment is successful in preventing recurrence.- - - - - - - - - - ranking = 2keywords = menstruation (Clic here for more details about this article) |
4/14. Cathamenial pneumothorax.Cathamenial pneumothorax is a relatively low-frequency pathology (approximately 100 cases cited in the literature) characterized by recurrent pneumothorax episodes during the menstruation period. We report on a 34-year-old female patient who had recurrent pneumothorax that did not respond to chest drainage and whose presentation was directly related to the menstruation period. Our patient also had a significant clinical record for pelvic endometriosis. She underwent video-assisted thoracoscopic exploration (VATS) of the pleural cavity and dystrophic parenchymal blebs of the middle lobe were found. An atypical resection of the bollous tissue was performed and pleurodesis completed the intervention. During VATS no ectopic endometriosis foci or diaphragmatic fenestrations (widely considered as a possible cause of this clinical picture) were evidenced.- - - - - - - - - - ranking = 2keywords = menstruation (Clic here for more details about this article) |
5/14. Nonsurgical treatment of a catamenial pneumothorax with a Gn-RH analogue.Catamenial pneumothorax is a rarely encountered entity characterized by recurrent pneumothorax concurrent with menstruation. Numerous mechanisms have been postulated in the etiology of catamenial pneumothorax and treatment is still controversial. We report a case of a catamenial pneumothorax successfully treated with a Gn-RH analogue supporting the efficacy of this regimen and the endometriosis theory as an underlying cause of the disease.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
6/14. Catamenial pneumothorax.Catamenial pneumothorax is defined as spontaneous pneumothorax occurring within 72 hours before or after onset of menstruation. Although catamenial pneumothorax is the most common clinical manifestation of intrathoracic endometriosis, this latter condition is not universally identified in women with catamenial pneumothorax and cannot fully explain the recurrent and cyclical episodes of pneumothorax. Therefore, the etiology of this syndrome is unknown, although many theories have been proposed to explain it. We describe a 37-year-old woman with recurrent episodes of spontaneous right-sided pneumothorax and chest pain that occurred close to her menstrual periods. The patient's condition did not abate after initial surgical exploration with abrasive mechanical pleurodesis or after hormonal suppressive therapy at an institution elsewhere. The patient was referred to our institution for further evaluation. A second surgical inspection of the pleural cavity and diaphragm disclosed the presence of multiple diaphragmatic fenestrations that were closed surgically at that time. Postoperatively, the patient discontinued hormonal suppressive therapy, and menstrual cycles became regular. Six months after surgery, the patient remains asymptomatic with no evidence of recurrence of pneumothorax. This case supports recent reports that diaphragmatic defects are often present in patients with catamenial pneumothorax. Surgical exploration to inspect the diaphragm and to close all Identified defects should be performed in patients who continue to experience pneumothorax despite effective hormonal suppression.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
7/14. A very rare entity: catamenial pneumothorax.Catamenial pneumothorax, a variant of spontaneous pneumothorax occurs exclusively in women of menstrual age. Catamenial pneumothorax is associated with a high rate of recurrence. The etiology and pathogenesis is enigmatic. We describe the case of a 42-year-old woman with right-sided catamenial pneumothorax recurring four times, caused by ectopic endometriosis in the pleural layers which was confirmed histopathologically. Surgical treatment should be accomplished during menstruation for optimal visualization of pleurodiaphragmatic endometriosis.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
8/14. Left-side catamenial pneumothorax with endometrial tissue on the visceral pleura.We present here a rare case of left-side catamenial pneumothorax, in which endometrial tissue pleura was found on the visceral pleura histologically. A chest roentogenogram confirmed the left pneumothorax, but did not reveal bullae or any associated anomalies, in a 41-year-old woman with three documented episodes of left-side pneumothorax occurring every menstruation. Video-assisted thoracoscopic surgery revealed not only tiny holes in the diaphragm, but also a scattered small brown spots on the visceral pleura. Histological examination of the lung sections revealed the existence of endometrial tissue on the visceral pleura with disrupted pleural elastic fibers. Our case suggests that cyclic erosion of the visceral pleura by the implanted endometrial tissue caused air leakage from the lung, in addition to the most accepted concept that air is aspirated into the thoracic cavity via the abdomen through the acquired fenestration of the diaphragm.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
9/14. Catamenial pneumothorax: report of a case and review of the Japanese and non-Japanese literature.A case of catamenial pneumothorax (CPT) was presented. The patient is a 34-year-old Japanese woman who had two histories of right pneumothorax occurring simultaneously with the menstruation. A thoracotomy, several blue cysts and tiny perforations were noted in the diaphragm. Partial excision of the lesion gave a favorable result. Pathological examination of the excised diaphragm revealed an endometriosis. Fisterography of the perforations at thoracotomy showed the pathway between thoracic and abdominal space. But the contrast medium didn't spread widely into the abdomen, but remained localized at the right paracolonic space, in accord with the right side predominancy of the endometriosis of the diaphragm which causes the CPT. The clinical and pathological features in Japanese cases including our own case are compared with those in English literature.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
10/14. Catamenial pneumothorax--a literature review and report of an unusual case.As already mentioned, only a few cases of CPT were described in the international medical literature, though there probably are some publications in languages unknown to us. It is quite possible that this syndrome is much more common than known to us, but until now there has been a lack of awareness of it. It may be presumed that in some of the cases of women complaining of some discomfort during menstruation, thorough examination would reveal a mild spontaneous pneumothorax which doesn't require any special treatment and is self-resolving; but most gynecologists are not thoroughly aware of this entity. While examining the clinical findings it is possible to demonstrate that this syndrome has its own clinical characteristics, totally different from those of spontaneous pneumothorax in the population as a whole. One of the characteristics of the syndrome is the assumption that women who do not ovulate, as women during the menarche, pregnant women and women taking contraceptive medications, are not subject to CPT. A case described in this review contradicts this assumption, although treatment with ovulatory suppressants, successfully used so far, should not be undervalued. The etiology and pathogenesis of this syndrome was and still is enigmatic. The accumulated knowledge so far does not point to any one etiologic factor. Therefore the suggested treatment, before definitive operative treatment, is so far experimental only, and its chances of success in any particular case are unpredictable.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
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