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Ann Thorac Surg 2003;75:1683-1684
© 2003 The Society of Thoracic Surgeons

Correspondence

A suggestion regarding catamenial pneumothorax

Henry F. Tripp, Jr, MDa

a Duke Cardiovascular Surgery of Danville, 207 S. Main St, Suite 3200, Danville, VA 24541, USA

(Email: htrippmd{at}aol.com).

To the Editor:

I read with great interest the article by Roth and associates [1] describing a case of catamenial pneumothorax in which they radiographically "captured" an air bubble transgressing from a fenestration within the diaphragm. I have previously demonstrated the presence of diaphragmatic fenestrations in this condition in a video published on the Internet[2]. I agree with Roth and coworkers that the theory of the air passing through such defects may indeed be valid in explaining the pathophysiology of catamenial pneumothorax.

More importantly, the authors highlight the lack of appreciation of this condition and the uncertainties involving its treatment, particularly with regard to hormonal suppression. Since the majority of spontaneous pneumothoraces occur in males, the presence of a spontaneous pneumothorax in a young female patient should alert the astute clinician to suspect catamenial pneumothorax. Because of the low incidence of diagnosed catamenial pneumothorax, there are no randomized studies of treatment efficacy. Currently, the best evidence is from accumulated series and seems to indicate that surgery combined with adjunctive hormonal therapy is the most efficacious treatment[3, 4]. In my experience, this is best accomplished with videoscopic-assisted thoracocopic surgery (VATS) and the use of gonadotropin releasing hormone analogues (GnRHs). Recent publicity surrounding the use of exogenous estrogen replacement makes this an even more attractive approach.

I have received numerous e-mails from patients around the world with presumed catamenial pneumothoraces, and I can attest to the lack of appreciation of this condition and the confusion surrounding its treatment. Therefore, I propose that the Society of Thoracic Surgeons or the American College of Chest Physicians establish a registry of patients with the diagnosis of catamenial pneumothorax. Information regarding the diagnosis, treatment and subsequent clinical course could be compiled and periodically reviewed so as to establish the optimum diagnostic and therapeutic approach to the condition and to create appropriate clinical guidelines.


   References
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 References
 

  1. Roth T, Alifano M, Schussler O, Magdeleinat P, Regnard J-F. Catamenial pneumothorax. chest X-ray sign and thoracoscopic treatment. Ann Thorac Surg 2002;74:563-565.[Abstract/Free Full Text]
  2. Tripp HF, Thomas LP, Obney JA. Current therapy of catamenial pneumothorax Heart Surg Forum 1998;1:146-149.[Medline]
  3. Joseph J, Sahn SA. Thoracic endometriosis syndrome. new observations from an analysis of 110 cases. Am J Med 1996;100:164-170.[Medline]
  4. Blarco S, Hernando P, Gomez A, Gonzalez MJ, Torres AJ, Balitorea JL. Catamenial pneumothorax caused by diaphragmatic endometriosis Thorac Cardiovascular Surg 1998;116:179-180.



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