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Photograph of a specimen from a partial diaphragmatic resection obtained during video-assisted thoracotomy. Both the holes and the nodules are evident.
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To evaluate the incidence of catamenial pneumothorax (CP) among women who have been referred for the surgical treatment of spontaneous pneumothorax (SP) and to study its pathogenic mechanisms.
A prospective study of women of reproductive age who have been referred to our center for the surgical treatment of SP. Patients with pneumothorax secondary...
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Background:
Bullectomy with pleural procedure is the most effective means of treating primary spontaneous pneumothorax (PSP). However, recurrences after thoracoscopic bullectomy are unexpectedly frequent. Our aim was to identify the premonitory imaging features after thoracoscopic bullectomy that may associate with recurrences in PSP.
Methods:
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Background:
The development of single-port thoracoscopic surgery and two-lung ventilation reduced the invasiveness of minor thoracic surgery. This study aimed to evaluate the feasibility and safety of single-port thoracoscopic bleb resection for primary spontaneous pneumothorax using two-lung ventilation with carbon dioxide insufflation.
Methods:...
Citations
... Catamenial Pneumothorax (CP) account for 2.5-5% o f c a s e s i n w o m e n w i t h s p o n t a n e o u s 19,20 pneumothorax, even though it accounts for 73% of cases of TES. The first case of CP was described by Maurer et al in 1958 but the term CP was not introduced until 1972 CP described as spontaneous and recurrent occurring within 72hours following 21 onset of menstruation. ...
... In the case of wide spread parenchymal endometriotic nodules or large lesions, the appropriate operative course is a parenchymal sparing procedures such as wedged resection with stapling device, segmentectomy, or in some cases, 9,19 lobectomy. Other alternative intervention for TES is pleurodesis, this can be done mechanically with pleural abrasion and partial pleurectomy at 9 VAT or chemically done with talc or tetracycline. ...
Background: The presence of endometrial tissue in the tracheobronchial tree, pleural, and lung is normally referred to as thoracic endometriosis. The association of catamenial pneumothorax, catamenial haemothorax, catamenial haemoptysis and pulmonary nodules is referred to as thoracic endometriosis syndrome (TES). TES is rare but not as rare as it has always been thought of. Case summaries: Case 1: We present EA, a 26-year-old chef/baker who presented to our unit on account of recurrent cyclical right sided chest pain and difficulty in breathing, recurrent haemoptysis and cyclical abdominal pain and swelling with multiple tender umbilical nodules. On general physical examination she was found to be in respiratory distress but not cyanosed with peripheral arterial oxygen saturation 97% on room air. Examination of the chest revealed a right sided chest fullness and reduced movement with breathing. Percussion note was stony dull and absent of breath sound on right hemithorax. Abdominal examination revealed a moderately distended abdomen with positive fluid thrill. Both Pleurocentesis (thoracocentesis) and paracentesis abdominis yielded a haemorrhagic fluid acellular and pleural and lung biopsy demonstrated endometrial stroma and glands. Imaging examination by way of chest X-ray showed a homogenous opacity of the right hemithorax, and pulmonary nodule following drainage. A diagnosis of Thoracic Endometriosis Syndrome was made. She had VAT with lung and pleural biopsy, pleural abrasion and a thoracostomy tube drainage. Case 2: We present IAE, a 29year-old Po+0 who presented to our unit on account of recurrent cyclical right sided chest pain and difficulty in breathing, unproductive cough. On general physical examination she was found to be in moderate respiratory distress but not cyanosed with peripheral arterial oxygen saturation of 98% on room air. Chest examination revealed an apical flattering of anterior chest wall with left trachea deviation. Percussion note was stony dull on the right lower third and hyper resonance middle and upper zones of right hemithorax. Pleurocentesis (thoracocentesis) yielded air and haemorrhagic fluid acellular and pleural and lung biopsies demonstrated endometrial stroma and glands. Imaging examination by way of chest X-ray and chest CT-scan showed air fluid level of the right hemithorax. A diagnosis of TES was made. She had Laparoscopy and VAT at the same sitting with pleural and lung biopsies. She was managed medically after closed thoracostomy tube drainage. She had partial collapse of right lower lobe and thoracotomy with right lower lobectomy was planned but patient declined. She also had Stage IV endometriosis by (rASRM)/ENZIAN systems Case 3: We present JA a 29-year-old lady, a filling station attendant who presented to our unit with a history of gradual onset of right sided chest pain, progressive difficulty in breathing and non-productive cough, and abdominal pain and swelling. On general physical examination she was found to be in respiratory distress but not cyanosed with SPO2 of 98% on room air. Examination of the chest revealed a right apical flattening, reduced ipsilateral chest movement with breathing. Percussion notes were stony dull and absent air entry on the ipsilateral hemithorax. Abdominal examination showed a mildly distended abdomen with a positive shifting dullness. Both Pleurocentesis (thoracocentesis) and paracentesis abdominis yielded a haemorrhagic fluid acellular at cytology and pleural and lung biopsy demonstrated endometrial stroma and gland. Imaging examination by way of chest X-ray showed a homogenous opacity of the right hemithorax. A diagnosis of Familial Thoracic Endometriosis Syndrome (FTES). Had USS guided lung and pleural biopsy and a thoracostomy tube drainage. She had chemical pleurodesis with tetracycline Conclusion: Thoracic endometriosis syndrome is the diagnosis in a lady of reproductive age who present with cyclic or a cyclical recurrent right sided chest pain, cyclical or a cyclical dyspnoea, haemoptysis, cyclical or a cyclical abdominal swelling and peritonitis.
... The most common clinical presentation of TE is catamenial pneumothorax [1,2,[4][5][6][7]. However, it is also known that absence of TE can occur, associated with diaphragmatic defects [8]. Catamenial pneumothorax was initially described in 1958 by Maurer, et al. [9]. ...
... It occurs mostly in adult women, with a peak of incidence between 30-35 years. It is characterized by recurrent pneumothoraces, in perimenstrual period, usually occurring within 72 hours before or after onset of menstruation [1,8,10], mostly in the right hemithorax [1,4,6,8,10]. It corresponds to 3-6% of cases of recurrent spontaneous pneumothorax and a third of all cases of spontaneous pneumothorax in women at reprodutive age [1,2,4]. ...
... It occurs mostly in adult women, with a peak of incidence between 30-35 years. It is characterized by recurrent pneumothoraces, in perimenstrual period, usually occurring within 72 hours before or after onset of menstruation [1,8,10], mostly in the right hemithorax [1,4,6,8,10]. It corresponds to 3-6% of cases of recurrent spontaneous pneumothorax and a third of all cases of spontaneous pneumothorax in women at reprodutive age [1,2,4]. ...
... C'est donc un examen clé pour orienter le siège thoracique des symptômes respiratoires, le côté atteint, l'abondance de l'épanchement gazeux ou liquidien [22]. La tomodensitométrie thoracique est l'examen de première intention qui trouve son intérêt surtout pendant les règles permettant de bien localiser l'implant endométrial, mais surtout orienter la stratégie de la prise en charge chirurgicale [17,18,23]. ...
... Dans le cas de notre patiente, qui n'a pas pu réaliser l'IRM, la vidéo thoracoscopie avait permis une exploration complète de des 2 cavités pleurales associée à une biopsie d'une lésion pleurale dont l'étude histologique était en faveur d'une endométriose thoracique. Concernant le type de traitement hormonal, aucune étude n'a démontré la supériorité des uns par rapport aux autres [9,17,26,27]. ...
Introduction. L'endométriose est définie par la présence de glandes et/ou de stroma endométrial en dehors de l'utérus
... Right catamenial pneumothorax could happen when endometrial tissue circulates with the clockwise position of peritoneal fluid in the abdominal cavity down into the left peritoneal gutter up to the right gutter to the peritoneal surface of the right diaphragm. 1,7 Our patient had a video-assisted thoracoscopic surgery to diagnose and treat thoracic endometriosis. From the VATS, we found blueberry spots near the diaphragm's tendons and multiple diaphragmatic perforations. ...
... We will perform a long-term follow-up on our patient as an evaluation to prevent the recurrence. 3,7,9 In conclusion, catamenial pneumothorax is a rare primary spontaneous pneumothorax that mostly happens in productive-age females within 72 h before and after the menstrual onset. Chest tube drainage is the first procedure to release the air and lead to lung expansion. ...
Catamenial pneumothorax is a rare primary spontaneous pneumothorax associated with the menstrual phase and is the most common manifestation of thoracic endometriosis syndrome. We report a case of a 32-year-old woman with a history of endometriosis who presented to the emergency ward with a chief complaint of dyspnea and right-sided chest pain, and a chest X-ray showed a right pneumothorax. Initial management was by placing a chest tube to expand the right lung. The patient underwent a video-assisted thoracoscopy and talc pleurodesis, during which we found multiple perforations in the tendinous part of the diaphragm. A partial resection of the tendinous part of the diaphragm was done. Our review indicated that primary spontaneous pneumothorax in women should be suspected as catamenial pneumothorax due to thoracic endometriosis. The gold standard procedure for diagnosis and treatment is surgery. Hormonal therapy is an effective choice to prevent and reduce post-operative recurrence.
... However, these findings may also reflect thoracic endometriosisa diagnosis that clinicians ought to consider when patients present with this constellation of symptoms. Despite the diagnostic challenges, thoracic endometriosis can be effectively controlled with hormonal treatment options, which means that patients desiring fertility preservation can avoid surgical menopause [8]. Herein, we report a case of thoracic endometriosis occurring in a woman in her late 30s successfully managed with hormonal therapy following fertility-sparing surgical treatment. ...
... Though effective, the use of GnRH analogues is limited to only up to six months as these agents simulate menopause and lead to bone loss, hot flashes, and vaginal dryness with extended use [20]. Patients who are refractory to medical treatment or experience recurrent disease may require surgical treatment with postoperative hormonal therapy [8]. Fertility-sparing surgical treatment options include VATS with excision of endometriotic lesions followed by hormonal treatment to reduce the risk of recurrence [8]. ...
... Patients who are refractory to medical treatment or experience recurrent disease may require surgical treatment with postoperative hormonal therapy [8]. Fertility-sparing surgical treatment options include VATS with excision of endometriotic lesions followed by hormonal treatment to reduce the risk of recurrence [8]. Definitive surgical intervention in the form of bilateral salpingo-oophorectomy and hysterectomy is an effective therapeutic option with low recurrence rates and is particularly worthwhile in women who no longer desire fertility [4]. ...
Thoracic endometriosis is an exceedingly rare condition characterized by the presence of endometriotic deposits on the diaphragm, lungs or pleural space. Patients may present with massive hemothorax, pneumothorax, hemoptysis or pulmonary nodules. It is a complex condition that often proves to be a diagnostic challenge, resulting in under-diagnosis, delays in treatment and significant morbidity in women of reproductive age. We report a case of endometriosis causing massive pleural effusion and ascites, with a left adnexal fibroid mass mimicking Meigs' syndrome in a nulliparous woman in her late 30s. The patient was successfully managed with hormonal therapy following fertility-sparing surgical treatment. This case highlights the diagnostic and therapeutic challenges associated with thoracic endometriosis because of its close resemblance to more sinister gynecological conditions. Hormonal therapy is the long-term treatment of choice in patients with thoracic endometriosis to reduce the risk of symptom recurrence and preserve fertility.
... Pneumothorax in women of childbearing age The overall incidence of pneumothorax is lower among females; however, there are unique conditions that present with recurrent spontaneous pneumothorax and occur only, or predominantly, in women of childbearing age. 88,89 Based on clinical and pathologic findings, pneumothorax in women of childbearing age is classified into three groups: (1) catamenial pneumothorax (with or without endometriosis), (2) endometriosis-related noncatamenial pneumothorax (pneumothorax occurring outside the menstrual period but with pathologic findings of endometriosis), and (3) idiopathic pneumothorax (noncatamenial and nonendometriosis with no underlying cause identified). 90 Catamenial pneumothorax is associated with the menstrual cycle and typically occurs within 72 hours before and after the onset of menstrual period. ...
Pneumothorax is a common problem worldwide. Pneumothorax develops secondary to diverse aetiologies; in many cases, there may be no recognizable lung abnormality. The pathogenetic mechanism(s) causing spontaneous pneumothorax may be related to an interplay between lung-related abnormalities and environmental factors such as smoking. Tobacco smoking is a major risk factor for primary spontaneous pneumothorax; chronic obstructive pulmonary disease is most frequently associated with secondary spontaneous pneumothorax. This review article provides an overview of the historical perspective, epidemiology, classification, and aetiology of pneumothorax. It also aims to highlight current knowledge and understanding of underlying risks and pathophysiological mechanisms in pneumothorax development.
... Pneumothorax in women of childbearing age The overall incidence of pneumothorax is lower among females; however, there are unique conditions that present with recurrent spontaneous pneumothorax and occur only, or predominantly, in women of childbearing age. 88,89 Based on clinical and pathologic findings, pneumothorax in women of childbearing age is classified into three groups: (1) catamenial pneumothorax (with or without endometriosis), (2) endometriosis-related noncatamenial pneumothorax (pneumothorax occurring outside the menstrual period but with pathologic findings of endometriosis), and (3) idiopathic pneumothorax (noncatamenial and nonendometriosis with no underlying cause identified). 90 Catamenial pneumothorax is associated with the menstrual cycle and typically occurs within 72 hours before and after the onset of menstrual period. ...
Pneumothorax is a common clinical problem worldwide. Pneumothorax is defined as presence of air in the pleural cavity. It can develop secondary to diverse etiologies including traumatic, inflammatory, infective, malignant, genetic, and hormonal causes; in many cases, the lung appears normal and there may be no recognizable underlying lung abnormality. The severity of clinical manifestations in a patient with pneumothorax ranges from asymptomatic to life-threatening, and may be disproportionate to pneumothorax size. In this review, we provide an overview of the historical perspective, epidemiology, classification, and etiology of pneumothorax. We also explore current knowledge and understanding of underlying risks and pathophysiologic mechanisms that lead to development of pneumothorax
... The European Society of Human Reproduction and Embryology guideline on the management of endometriosis were only able to make GRADE D level recommendations broadly addressing all forms of extragenital endometriosis. (Dunselman et al., 2014;Neumann et al., 2015) A guideline for the management of thoracic endometriosis published in 2018 by the Collège National des Gynécologues et Obstétriciens Français in conjunction with Haute Autorité de Santé (Merlot et al., 2018) included ten studies evaluating diagnostic (Alifano et al., 2003;Marshall et al., 2005), or therapeutic interventions (Ceccaroni et al., 2012;Duyos et al., 2014;Leong et al., 2006;Nakashima et al., 2011;Nezhat et al., 1998, Nezhat et al., 2014 BSGE members that patients would benefit from multidisciplinary care at a regional or national centre. This underlines the importance of developing a national consensus among all stakeholders on the diagnosis and management of women with thoracic endometriosis within a dedicated multidisciplinary service at a specialised centre. ...
Abstract
Objectives: This study evaluates current national opinions on screening, diagnosis, and management of thoracic
endometriosis.
Background: Thoracic endometriosis is a rare but serious condition with four main clinical presentations:
pneumothorax, haemoptysis, haemothorax, and pulmonary nodules. There are no specialist centres in the
United Kingdom despite growing patient desire for recognition, investigation, and treatment.
Methods: We distributed a multiple-choice email survey to senior members of the British Society for
Gynaecological Endoscopy. Descriptive statistics were used to present the results.
Results: We received 67 responses from experienced clinicians having provided over 800 combined years of
endometriosis patient care. The majority of respondents managed over 100 endometriosis patients annually, for
more than five years. Over one third had never managed a patient with symptomatic thoracic endometriosis; just
9% had managed more than 30 cases over the course of their career. Screening varied by modality with only 4%
of clinicians always taking a history of respiratory symptoms while 69% would always screen for diaphragmatic
endometriosis during laparoscopy. The management of symptomatic thoracic endometriosis varied widely with
the commonest treatment being surgery followed by hormonal therapies. Regarding management, 71% of
respondents felt the team should comprise of four or more different specialists, and 56% believed care should
be centralised either regionally or nationally.
Conclusions: Thoracic endometriosis is poorly screened for amongst clinicians with varied management lacking
a common diagnostic or therapeutic pathway in the United Kingdom. Specialists expressed a preference for
women to be managed in a large multidisciplinary team setting at a regional or national level.
... The number of patients for each paper ranged from 8 to 150, with a median of 15 patients. In fifteen studies 5,[13][14][15][16][17]19,22,25,26,28,29,32,33 the first author was a thoracic surgeon, in 7 a gynecologist 18,21,23,27,31,34,35 , in 2 a pathologist 12,30 , and in 1 study a respiratory physician 20 . In most of the cases, the cohort of patients were treated at a single institution. ...
... Almost all of the patients in 12 studies 5,13,16,18,20,21,[23][24][25][26][27]31 also underwent a gynecologic evaluation and pelvic magnetic resonance imaging (MRI) or pelvic ultrasound to investigate the presence of pelvic endometriosis, with an overall pooled prevalence of 96% (95% CI 87-100). ...
... J o u r n a l P r e -p r o o f Twenty-two trials 5,[12][13][14][15][16][17][18][19][22][23][24][25][26][27][29][30][31][32][33][34][35] evaluated the prevalence of video-assisted thoracic surgery (VATS) for the treatment of TES, which has been used in the majority of cases (84%, 95% CI 66-96). The need for thoracotomy was reported by 15 studies 5,[12][13][14][15]19,[22][23][24][25][26][27]29,32,33 , with a pooled prevalence of 18% of patients (95% CI 5-34). ...
Background
Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of functional endometrial tissue within the chest cavity. Up to 80% of women with TES present with concomitant pelvic endometriosis. The diagnostic-curative path is defined by both thoracic surgeons and gynecologists, consistent with the manifestation of the disease. The aim of the study was to analyze the different approaches to generate an ideal diagnosis-treatment algorithm that can be shared by both specialties.
Methods
We searched PubMed and Scopus for studies that were completed by March 2019 and that included at least 8 patients with TES. Information on preoperative exams, surgical technique, postoperative management, and recurrence of disease was collected for meta-analysis.
Results
Twenty-five studies including a total of 732 patients were eligible. Almost all of the patients underwent radiologic pelvis investigation (96%; confidence interval [CI] 87-100). Videothoracoscopy was the preferred surgical technique (84%; 95% CI 66-96). Intraoperative evaluation revealed the presence of diaphragmatic anomalies in 84% of cases (95% CI 73-93). The overall pooled prevalence of concomitant or staged laparoscopy was 52% (95% CI 18-85). Postoperative hormone therapy was heterogeneous with a pooled prevalence of 61% (95% CI 33-86; I²=95.6%; p<0.01). Recurrence of symptoms was documented in 27% of patients (95% CI 20-34; I²=54.7%; p<0.01).
Conclusions
TES should be managed jointly by thoracic surgeons and gynecologists. Chest-abdomen magnetic resonance imaging seems to offer the most details for TES. Combined or staged videothoracoscopy and laparoscopy can provide adequate information to fine-tune proper surgical treatment and postoperative medical therapy.
... Several theories concerning the endometriosis related CP has been proposed. They all conflate around the idea of increased fallopian tube permeability in peri menstrual period combined with the fenestration in diaphragmic wall due to a congenital defect or more often seen endometrial metastatic lesions found on the surface of diaphragm that can damage the soft tissue of diaphragm and open the pathway to lung pleura [1,7,8,[14][15][16][17]. In some cases the endometrial cells continue their migration through the diaphragm and form endometrial nodules on the surface of the pleura [8]. ...
... Accompanied by hematochezia, hemothorax and radiologically apparent endometrial nodules on the pleura it refers to a specific entity called thoracic endometriosis syndrome (TES). It's occurrence corelates with existence of pelvic endometriosis in around 50 -70%, where the thoracic endometriosis occurred approximately 5 years later [3,7,[14][15][16][17][18]. As previously detailed, difference in the mean age occurrence between pelvic and thoracic endometriosis may be explained with the time necessary for endometrial tissue to migrate through the right diaphragm [16]. ...
... Accompanied by hematochezia, hemothorax and radiologically apparent endometrial nodules on the pleura it refers to a specific entity called thoracic endometriosis syndrome (TES). It's occurrence corelates with existence of pelvic endometriosis in around 50 -70%, where the thoracic endometriosis occurred approximately 5 years later [3,7,[14][15][16][17][18]. As previously detailed, difference in the mean age occurrence between pelvic and thoracic endometriosis may be explained with the time necessary for endometrial tissue to migrate through the right diaphragm [16]. Catamenial pneumothorax is found to be associated with both thoracic and pelvic endometriosis, although endometrial character of the disease cannot be confirmed histologically in every case [7,9]. ...
Background: Catamenial pneumothorax is the most common form of thoracic endometriosis syndrome. It occurs around the beginning of a menstrual cycle. Although the mechanism of catamenial pneumothorax is not definitely clear, endometriosis plays an important role in it. Video-assisted thoracic surgery is standard procedure for the treatment of recurrent pneumothorax in general. Case study: We report on a case of catamenial pneumothorax in women with a history of recurring spontaneous pneumotoraces associated with diaphragmatic endometrial implants who is involved in the IVF procedure. Conclusion: Combination of video-assisted thoracoscopic surgery (VATS) and gonadotropin-releasing-hormone analogue gives the best results, to reduce the risk of pneumothorax to recur. Treatment of catamenial pneumothorax is complex and should include thoracic surgeon and gynecologist as soon as the diagnosis is definitive.
