Nonresolving Pneumothorax in a Case of Catamenial Pneumothorax

This video shows a rare case of clinical catamenial pneumothorax with intraoperative visualization of pleural peritoneal windows in a previously healthy thirty-eight-year-old woman. She presented with a nonresolving right-sided pneumothorax. Her history was significant for a progesterone implant contraceptive, which she reported as no longer functioning as well. When taken for VATS, pleural peritoneal windows were identified within the diaphragm. These were repaired with Stratafix sutures. 

Chest X-rays on postoperative day two, compared to postoperative day zero, showed increased subdiaphragmatic free air. Presumably, this would not have come from the thorax, as the defects were closed. One theory of catamenial pneumothoraxes is “retrograde menstruation” with diaphragmatic migration of endometrial cells, creating defects within the diaphragm, which allows air to pass from the abdominal cavity to thoracic cavity during menses. This could account for the increased subdiaphragmatic air seen postoperatively.

Reference(s)

Andres MP, Arcoverde FVL, Souza CCC, Fernandes LFC, Abrão MS, Kho RM. Extrapelvic Endometriosis: A Systematic Review. J Minim Invasive Gynecol. 2020;27(2):373-389. doi:10.1016/j.jmig.2019.10.004

Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: A review. Reprod Med Biol. 2020;19(4):323-333. doi:10.1002/rmb2.12340

Forster C, Bénière C, Lattion J, Perentes JY, Christodoulou M. Evolutive diaphragmatic lesions causing recurrent catamenial pneumothorax. Thorax. 2022;77(1):105. doi:10.1136/thoraxjnl-2021-217044