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J Cases Obstet Gynecol, 2017;4(4):80-83


           J o u r n a l   o f   C a s e s   i n                                     Volume 4 Issue 4 October 2017                    J o u r n a l   o f   C a s e s   i n
           Obs tetrics & G ynecology                                                                                                  Obs tetrics & G ynecology
                                                                                                                                   Case Report


         Senior Editor                                                 Editorial Board                                             Recurrent Catamenial Pneumothorax: A Diagnostic Challenge

         Erkut Attar, MD, PhD, Istanbul, Turkey                        Shailesh Puntambekar, MD, Pune, India
         Istanbul University Faculty of Medicine, Depart-              Seema Puntambekar, MD, Pune, India
         ment of Obstetrics and Gynecology, Istanbul,                  Cecilia Sjoblom, MD, PhD, Sydney, Australia
         Turkey                                                        Fatih Sendag, MD, Izmir, Turkey                             Kerry HOWATT , Kenneth REID , Robert L. REID 1,*
                                                                                                                                                           2
                                                                                                                                               1
                                                                       Tayfun Gungor, MD, Ankara, Turkey
         Editor-in-Chief                                               Ahmet Kale, MD, Kocaeli, Turkey                             1 Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
         Bulent Yilmaz, MD, Izmir, Turkey                              Emre Okyay, MD, Izmir, Turkey                               2 Department of Surgery, Division of Cardiothoracic Surgery, Queen’s University, Kingston, Ontario, Canada
         Gozde Izmir Hospital, Obstetrics and                          Kurtulus Ongel, MD, Izmir, Turkey                           Abstract
         Gynecology Clinic, Izmir, Turkey                              Yusuf Yildirim, MD, Izmir, Turkey                           Endometriosis is a common gynecologic condition that has variable clinical findings.  Typical signs and symptoms include dysmenorrhea, pelvic
         Serkan Kahyaoglu, MD, Ankara, Turkey                          Akin Sivaslioglu, MD, Izmir, Turkey                         pain, and infertility.  However, when endometrial deposits are located outside the pelvis, patients may present in a more unusual fashion.  We re-
         University of Health Sciences, Ankara Dr. Zekai Tahir         Cuneyt Eftal Taner, MD, Izmir, Turkey                       port  a  case  of  extra-pelvic  endometriosis  that  was  identified  following  treatment  for  recurrent  pneumothorax.  A  28-year-old  nulliparous  fe-
                                                                                                                                   male  presented  with  recurrent  pneumothorax  associated  with  her  menstrual  cycle.    Initial  thoracoscopic  surgery  identified  a  suspicious  apical
         Burak Women's Health Practice and Research Center             Isa Aykut Ozdemir, MD, Izmir, Turkey                        bleb.  Following its resection however, her symptoms persisted.  Ovarian suppression using a GnRH-agonist resulted in significant symptomatic
         Ankara, Turkey                                                                                                            control.   This prompted a second-look thoracoscopy with a gynecologist in attendance.  A right diaphragmatic deposit of ectopic endometriosis
                                                                       lrfan Ocal, MD, lzmir, Turkey                               was resected with resolution of the problem. We discuss current pathogenic theories of endometriosis and catamenial pneumothorax.  Additional-
         Secretary                                                     Deniz Oztekin, MD, Izmir, Turkey                            ly, we review the spectrum of presentation, dilemma of diagnosis, and available therapies used in the treatment of endometrial-associated pneu-
                                                                                                                                   mothorax.  We speculate on efficacy of novel therapies (e.g., dienogest) in the treatment of extrapelvic endometriosis.  This case study demon-
         Onur Ince, MD, Izmir, Turkey                                  Yunus Aydin, MD, Eskisehir, Turkey                          strates  the  benefit  of  empiric  treatment  with  ovulation  suppression  when  other  diagnostic  modalities  proved  inconclusive.    Furthermore,  it
                                                                       Abdullah Karaer, MD, Malatya, Turkey                        highlights the importance of interdisciplinary care and stresses the need for increased awareness of endometriosis in non-gynecologic specialties.
         Associate Editors                                             Gazi Yildirim, MD, Istanbul, Turkey                         Key Words:
         Baris Ata, MD, Msc, Bursa, Turkey                             Sivekar Tinar, MD, Izmir, Turkey                            Endometriosis; catamenial pneumothorax; thoracic endometriosis; menstrual suppression
         Serkan Kahyaoglu, MD, Ankara, Turkey                          Cemal Posaci, MD, Izmir, Turkey
         Ibrahim Egemen Ertas, MD, Izmir, Turkey                       Ahmet Zeki Isik, MD, Izmir, Turkey                          Introduction                                            thorax with have menstrually-related  disease [8].
         Cavit Kart, MD, Trabzon, Turkey                               Nuri Danisman, MD, Ankara, Turkey                                                                                   Various medical  and surgical  management  options for
         Kemal Gungorduk, MD, Izmir, Turkey                            Salih Taskin, MD, Ankara, Turkey                            Endometriosis  is relatively  common,  affecting  up to   CP have been described, used alone or in combination.
         Ali Akdemir, MD, PhD, Izmir, Turkey                           Mertihan Kurtoglu, MD, Ankara, Turkey                       15% of women [1].  While endometrial deposits are typ-  Medical options rely on ovulation suppression while sur-
         Eralp Baser, MD, Ankara, Turkey                               Levent Yasar, MD, Istanbul, Turkey                          ically  confined  to  the  pelvis,  other  locations  through-  gical options may be primarily gynecologic (e.g., hyster-
         Ahmet Baris Guzel, MD, Adana, Turkey                          Ali Gedikbasi, MD, Istanbul, Turkey                         out the body have been recognized [2].  Numerous theo-  ectomy  and oophorectomy)  or thoracic  (e.g., wedge re-
         Gurkan Bozdag, MD, Ankara, Turkey                             Seda Guven, MD, Trabzon, Turkey                             ries  of pathogenesis  for such extra-pelvic  disseminations   section, talc  pleurodesis) [9].    While  hysterectomy  and
         Hakan Aytan, MD, Mersin, Turkey                               Hayrettin Daskaya, MD, Istanbul, Turkey                     have been proposed, including  retrograde menstruation   surgical  castration  is  considered  “definitive  surgery”  for
         Suleyman Guven, MD, Trabzon, Turkey                           Emre Özgü,MD, Ankara, Turkey                                [3], coelomic  metaplasia  [4],  and  lymphatic  spread  [5].  endometriosis by many gynecologists [10], others ad-
                                                                                                                                                                                           vocate for more aggressive treatment  which includes
         Volkan Turan, MD, Izmir, Turkey                               Hasan Onur Topçu, MD, Ankara, Turkey                        Catamenial  pneumothorax  (CP)  is  defined  as  recurrent   the additional  resection  of any palpable  or visible  en-
         Ibrahim Egemen Ertas, MD, Izmir, Turkey                       Murat Öz, MD, Ankara, Turkey                                spontaneous  pneumothorax  occurring  in  women  which   dometriotic  lesions to avoid persistent  symptoms [11].
                                                                       Ömer Hamid Yumuşak,MD, Ankara,Turkey                        is temporally related with the onset of menses [6].  It is
                                                                       Kaan Osmanagaoglu, Gent, Belgium                            the  most  common  manifestation  of thoracic  endome-
                                                                       Mustafa Demir, MD, Gaziantep, Turkey                        triosis [7]. Estimates  suggest that  one-third  of repro-
                                                                                                                                   ductive-aged  women requiring  surgery for pneumo-      Case Presentation

                                                                                                                                   Article History:                                        A 28-year-old female presented with a history of recur-
                                                                                                                                   Received: 29/04/2017
                                                                                                                                   Accepted: 09/06/2017                                    rent  pneumothorax, which she believed  to be  associated
                                                                                                                                                                                           with her menstrual  periods.  She had a ten-year  history
                                                                                                                                   *Correspondence: Robert Reid, M.D.
                                                                                                                                   Address: Department of Obstetrics and Gynecology        of thoracic  symptoms associated  with the  onset of men-
                                                                                                                                   67 Stuart Street Kingston, Ontario, Canada, K7L 2V7     ses.  Initially  she had experienced  right upper quadrant
                                                                                                                                   Tel: 613-542-9473
                                                                                                                                   e-mail: robert.reid@queensu.ca
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