Catamenial pneumothorax due to solitary localization of diaphragmatic endometriosis

INTRODUCTION: Catamenial pneumothorax (CP) is a spontaneous recurrent pneumothorax occurring inwomen in reproductive age. The etiology of CP has been associated with thoracic endometriosis and isits most common presentation. PRESENTATION OF CASE: A case of right catamenial pneumothorax in a 38 year old woman is presented inwhich three episodes of CP occurred within 72 h of menses in a 6 month period. The patient underwentvideothoracoscopy that revealed a solitary localization of diaphragmatic endometriosis. After surgicalpleurodesis and based on final pathology of resected lesion, hormonal treatment was started. The outcomewas uneventful and the patients is symptom-free at 6 months. DISCUSSION: Catamenial pneumothorax (CP) is a rare clinical entity characterized by lung collapse duringmenstruation, believed to be secondary to pleural endometriosis. Nearly all catamenial pneumothoraxoccur on the right side as pleural lesions are almost exclusively right-sided. Diagnostic imaging is based onhigh resolution computed tomography (HRCT) and, preferably, magnetic resonance imaging (MRI) since itis able to detect the blood products in the endometrial deposits. However the lack of macroscopic findingsat surgery makes this condition still under-diagnosed. Based on the solitary diaphragmatic localizationof endometriosis in our case we preferred to limit surgery to videothoracoscopic pleurodesis and starthormonal treatment with successful outcome. CONCLUSION: Catamenial pneumothorax is the most common presentation of thoracic endometriosissyndrome and should always be suspected in women in childbearing age. Treatment option are stilldebated but best results are achieved by videothoracoscopic pleurodesis combined with hormonal ther-apy.