Ann Thorac Surg 2003;75:381
© 2003 The Society of Thoracic Surgeons
Invited commentary
Carolyn E. Reed, MD
Division of Cardiothoracic Surgery, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425-2279, USA
e-mail: reedce{at}musc.edu
Catamenial pneumothorax is an uncommon entity but will probably be seen at some point in most general thoracic surgeons’ careers. The article by Bagan and colleagues lends added evidence to the importance of diaphragmatic defects, with or without endometriosis, in the pathogenesis of this entity [1].
The search for diaphragmatic defects is essential, and thoracoscopy is the ideal tool. If no defect is seen, but blebs are identified, resection and pleural abrasion ± pleurectomy versus talc poudrage can be performed. This first step of pleurodesis seems reasonable since some pneumothoraces may result from embolized endometrial tissue to peripheral lung parenchyma and not involve defects in the diaphragm, and surgical pleurodesis has documented success [2]. In this regard, I would not favor using talc poudrage as the pleurodesis agent, since recurrence in the right basilar location, as reported in this series, would suggest there will be cases of missed diaphragmatic defects. At this point, thoracotomy and placement of mesh over the tendinous portion of the diaphragm are reasonable. Tale poudrage at initial thoracoscopy could add technical difficulty if a second procedure is necessary.
References
- Bagan P, LePimpec-Barthes F, Assouad J, Souilamas R, Riquet M. Catamenial pneumothorax: retrospective study of surgical treatment. Ann Thorac Surg 2003;75:378–81
- Joseph J., Sahn S.A. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med 1996;100:164-170.[Medline]
