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Endometriosis presenting as catamenial pneumothorax, pneumopericardium and pneumoperitoneum.

BMJ Case Rep

January 2025

Pulmonary Medicine, K S Hegde Medical Academy, Mangaluru, Karnataka, India

A nulliparous woman in her late 30s with a history of pericardial patch repair for atrial septal defect and completed treatment for pulmonary tuberculosis 9 years ago presented with chest pain, breathlessness and abdominal pain. Radiological imaging revealed right-sided pneumothorax, pneumopericardium and pneumoperitoneum for which an intercostal drain (ICD) was placed. A contrast-enhanced CT of the abdomen showed a distal stomach perforation, which was managed conservatively.

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This review presents current opinions on an uncommon condition called catamenial pneumothorax (CP), which is usually associated with thoracic endometriosis syndrome (TES). TES is characterized by the presence of endometriotic lesions in pleura and lung parenchyma and presents with various clinical signs and symptoms, including catamenial pneumothorax. Their diagnosis is often delayed.

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Endometriosis is a systemic, inflammatory, estrogen-dependent condition characterized by endometrial stroma and gland-like lesions outside of the uterus. It causes a range of symptoms, notably chronic pelvic pain, infertility and organ dysfunction. Thoracic endometriosis syndrome (TES) has been described as endometriosis that is found in the lung parenchyma, pleura and diaphragm.

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Introduction: There is a risk of iatrogenic vascular injuries during robotic-assisted laparoscopic excision of diaphragmatic endometriosis. Although studies are limited, the first reported case of a suprahepatic inferior vena cava (IVC) injury during robotic diaphragmatic endometriosis excision was successfully treated using a fibrin sealant patch, preventing exsanguination and conversion to laparotomy.

Case Description: A 36-year-old female with a history of recurrent catamenial pneumothorax and two prior video-assisted thoracoscopic surgeries to treat diaphragmatic endometriosis presented to our clinic with right-sided shoulder pain and a chest tube in place.

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Background Catamenial pneumothorax (CP) is characterized by pneumothorax associated with menstrual cycles and thoracic endometriosis. This study aimed to review the outcomes and trends for surgical treatment of CP in King Chulalongkorn Memorial Hospital. Methodology We included females aged 18 to 50 years who underwent surgery for CP between January 2012 and December 2022.

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