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Ann Thorac Surg 2000;69:1644
© 2000 The Society of Thoracic Surgeons

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Correspondence

Catamenial pneumothorax: a unifying concept

^a Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1028, New York, NY 10029, USA

To the Editor

Cowl and associates [1] are to be complimented on yet another documentation of a diaphragmatic defect accounting for the pathogenesis of catamenial pneumothorax. They mention that multifactorial causes are likely because of "a lack of a unifying source for each reported patient in the literature."

Recently I published an article entitled "Porous Diaphragm Syndromes" [2], which deals with and presents evidence for a "unifying source." Such seemingly disparate conditions as cirrhosis of the liver with ascites, laparoscopic operation, diagnostic and therapeutic pneumoperitoneum, peritoneal dialysis, Meigs’ syndrome, as well as catamenial pneumothorax and a few other miscellaneous conditions all exhibit the phenomenon of peritoneopleural transphrenic passage of fluids, blood, gases, tissues, or exudates by way of a common anatomic feature—a defect in the diaphragm.

The diaphragmatic defect has been identified in representative examples of each one of these conditions, albeit not in every single case. In a number of reports in the literature the statement was made that the search for such a defect was not thorough enough.

An unanswered question is whether the defect is congenital, acquired, or both as there seems to be evidence for each of these.

Lastly, it is important to differentiate pulmonary from pleural endometriosis. The former, evidenced by parenchymal pulmonary deposits, is presumed to be a result of vascular "metastasis" by way of the uterine veins [3], whereas the latter is considered to be a manifestation of Sampson’s theory of "retrograde menstruation" and transperitoneal transdiaphragmatic spread into the pleura [4]. The former presents as a pulmonary nodule at times peribronchial, often manifesting cyclical hemoptysis ("vicarious menstruation"), and not with pneumothorax.

I do not believe the prostaglandin release theory has anything to do with catamenial pneumothorax.

References

1. Cowl C.T., Dunn W.F., Deschamps C. Visualization of diaphragmatic fenestration associated with catamenial pneumothorax. Ann Thorac Surg 1999;68:1413-1414.[Abstract/Free Full Text]
2. Kirschner P.A. Porous diaphragm syndromes. Chest Surg Clin North Am 1998;8:449-472.[Medline]
3. Lattes R., Shepard F., Tovill A., et al. A clinical and pathologic study of endometriosis of the lung. Surg Gynecol Obstet 1956;103:552-558.
4. Sampson J.A. The development of the implantation theory for the origin of peritoneal endometriosis. Am J Obstet Gynecol 1940;40:549-557.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Paul A. Kirschner Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kirschner, P. A. Search for Related Content PubMed Articles by Kirschner, P. A. Related Collections Related Article