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'''Catamenial Pneumothorax''' is a condition of [[pneumothorax|collapsed lung]] occurring in conjunction with [[menstrual periods]] (catamenial refers to [[menstruation]]), believed to be caused primarily by [[endometriosis]] of the [[pleura]] (the membrane surrounding the [[lung]])<ref name=mercksource>[http://www.mercksource.com/pp/us/cns/cns_hl_dorlands.jspzQzpgzEzzSzppdocszSzuszSzcommonzSzdorlandszSzdorlandzSzdmd_p_25zPzhtm#12652312 Definition from mercksource.com (Dorlands Medical Dictionary)]</ref>. |
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{{cleanup-date|June 2006}} |
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{{wikify-date|June 2006}} |
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==Classification== |
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'''Catamenial Pneumothorax''': [[Pneumothorax]] occuring in conjunction with [[menstrual periods]], believed to represent a consequence of [[pleural]] [[endometriosis]]. This is the definition according to mercksource.com (Dorlands Medical Dictionary) Catamenial refers to Menstrual. |
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Catamenial Pneumothorax is the most common form of [[thoracic endometriosis syndrome]], which also includes [[catamenial hemothorax]], [[catamenial hemoptysis]] and [[endometriosis lung nodules]], as well as some exceptional presentations. |
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==Symptoms and signs== |
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The phenomenon known as catamenial hemopneumothorax, is when endometriosis attaches to the lung, releases fluid, and allows air to move in by an unknown mechanism-all of which causes the lung to collapse. This definition is from the book Living With Lung and Colon Endometriosis: Catamenial Pneumothorax. |
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Onset of long collapse is less than 72 hours after menstruation. Typically, it occurs in women aged 30-40 years (and exclusively in women of menstrual age) with a history of [[pelvis|pelvic]] [[endometriosis]]. |
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==Pathophysiology== |
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{{med-stub}} |
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Endometriosis can attach to the lung, forming chocolate-like [[cyst|cysts]]. Generally the parietal pleura is involved, but the lung itself, the visceral layer, the diaphragm, and more rarely the tracheobronchial tree may also be afflicted<ref name=AmJMed>Joseph J, Sahn SA. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. ''Am J Med'' 1996; '''100''': 164-70. PMID 8629650</ref> |
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. How this [[endometrium|endometrial tissue]] reaches the thorax remains enigmatic, although defects in the diaphragm can often be found<ref name=chest>Alifano M, Roth T, Broet SC, Schussler O, Magdeleinat P, Regnard JF. Catamenial pneumothorax: a prospective study. ''Chest'' 2003; '''124''': 1004-8. PMID 12970030</ref>. |
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The cysts can release [[blood]]; the endometrial cyst "menstruates" in the lung. Air can move in by an unknown mechanism. The blood and air cause the lung to collapse (''i.e.'' catamenial [[hemopneumothorax]])<ref name=book>Glynis D. Wallace. ''Living With Lung And Colon Endometriosis: Catamenial Pneumothorax''. Authorhouse, 2005. ISBN 1420883313</ref>. |
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==Diagnosis== |
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[[Diagnosis]] can be hinted by high recurrence rates of lung collapse in a woman of reproductive age with endometriosis. Nowadays, video-assisted [[thoracoscopy]] is used for confirmation. |
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==Treatment== |
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Pneumothorax is a [[medical emergency]] because it comes with severe [[pain]] and decreased lung function. A [[chest tube]] should be inserted after clinical assessment. This releases the air and menstrual blood, and the lung can re-expand. |
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Surgery, hormonal treatments and combined approaches have all been proposed, with variable results in terms of short and long term outcome. Surgical removal of the endometrial tissue should be endeavoured during menstruation for optimal visualisation of the cyst<ref name=asian>Poyraz AS, Kilic D, Hatipoglu A, Demirhan BA. A very rare entity: catamenial pneumothorax. ''Asian Cardiovasc Thorac Ann'' 2005; '''13''':271-3. PMID 16113003</ref>. Menstruation and accompanying lung collapse can be suppressed with [[hormone therapy]]<ref name=eMedicine>{{eMedicine|radio|563}}</ref>, like with [[danazol]] or [[oral contraceptives]]. |
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==Epidemiology== |
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Some sources claim this entity represents 3-6% of pneumothorax in women<ref name=eMedicine>{{eMedicine|radio|563}}</ref>. In regard of the low [[incidence]] of (primary spontaneous, ''i.e.'' not due to surgical trauma ''etc.'') pneumothorax in women (about 1/100'000/year)<ref name=eMedicine>{{eMedicine|radio|563}}</ref>, this is a very rare condition. Hence, many basic textbooks don't mention it, and many [[doctors]] have never heard of it<ref name=book>Glynis D. Wallace. ''Living With Lung And Colon Endometriosis: Catamenial Pneumothorax''. Authorhouse, 2005. ISBN 1420883313</ref>. However, catamenial pneumothorax is probably under-recognised<ref name=chest>Alifano M, Roth T, Broet SC, Schussler O, Magdeleinat P, Regnard JF. Catamenial pneumothorax: a prospective study. ''Chest'' 2003; '''124''': 1004-8. PMID 12970030</ref>. |
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==References== |
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Review article: Alifano M, Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge. ''Ann Thorac Surg'' 2006; '''81''': 761-9. PMID 16427904 |
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<references/> |
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[[Category:Gynecology]] |
[[Category:Gynecology]] |
Revision as of 10:09, 1 July 2006
Catamenial Pneumothorax is a condition of collapsed lung occurring in conjunction with menstrual periods (catamenial refers to menstruation), believed to be caused primarily by endometriosis of the pleura (the membrane surrounding the lung)[1].
Classification
Catamenial Pneumothorax is the most common form of thoracic endometriosis syndrome, which also includes catamenial hemothorax, catamenial hemoptysis and endometriosis lung nodules, as well as some exceptional presentations.
Symptoms and signs
Onset of long collapse is less than 72 hours after menstruation. Typically, it occurs in women aged 30-40 years (and exclusively in women of menstrual age) with a history of pelvic endometriosis.
Pathophysiology
Endometriosis can attach to the lung, forming chocolate-like cysts. Generally the parietal pleura is involved, but the lung itself, the visceral layer, the diaphragm, and more rarely the tracheobronchial tree may also be afflicted[2] . How this endometrial tissue reaches the thorax remains enigmatic, although defects in the diaphragm can often be found[3].
The cysts can release blood; the endometrial cyst "menstruates" in the lung. Air can move in by an unknown mechanism. The blood and air cause the lung to collapse (i.e. catamenial hemopneumothorax)[4].
Diagnosis
Diagnosis can be hinted by high recurrence rates of lung collapse in a woman of reproductive age with endometriosis. Nowadays, video-assisted thoracoscopy is used for confirmation.
Treatment
Pneumothorax is a medical emergency because it comes with severe pain and decreased lung function. A chest tube should be inserted after clinical assessment. This releases the air and menstrual blood, and the lung can re-expand.
Surgery, hormonal treatments and combined approaches have all been proposed, with variable results in terms of short and long term outcome. Surgical removal of the endometrial tissue should be endeavoured during menstruation for optimal visualisation of the cyst[5]. Menstruation and accompanying lung collapse can be suppressed with hormone therapy[6], like with danazol or oral contraceptives.
Epidemiology
Some sources claim this entity represents 3-6% of pneumothorax in women[6]. In regard of the low incidence of (primary spontaneous, i.e. not due to surgical trauma etc.) pneumothorax in women (about 1/100'000/year)[6], this is a very rare condition. Hence, many basic textbooks don't mention it, and many doctors have never heard of it[4]. However, catamenial pneumothorax is probably under-recognised[3].
References
Review article: Alifano M, Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge. Ann Thorac Surg 2006; 81: 761-9. PMID 16427904
- ^ Definition from mercksource.com (Dorlands Medical Dictionary)
- ^ Joseph J, Sahn SA. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med 1996; 100: 164-70. PMID 8629650
- ^ a b Alifano M, Roth T, Broet SC, Schussler O, Magdeleinat P, Regnard JF. Catamenial pneumothorax: a prospective study. Chest 2003; 124: 1004-8. PMID 12970030
- ^ a b Glynis D. Wallace. Living With Lung And Colon Endometriosis: Catamenial Pneumothorax. Authorhouse, 2005. ISBN 1420883313
- ^ Poyraz AS, Kilic D, Hatipoglu A, Demirhan BA. A very rare entity: catamenial pneumothorax. Asian Cardiovasc Thorac Ann 2005; 13:271-3. PMID 16113003
- ^ a b c radio/563 at eMedicine