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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,*
 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
        Journal of Cases in Obstetrics & Gynecology
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