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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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Journal of Cases in Obstetrics & Gynecology
