Catamenial Pneumothorax: A Case Series

Abstract

Background: Catamenial pneumothorax is a rare form of spontaneous pneumothorax characterized by recurrent episodes occurring within 72 hours of the onset of menstruation. It is most frequently observed in women between 30 and 40 years old. Although the exact cause remains unproven, prevailing hypotheses propose that congenital diaphragmatic fenestrations may permit translocation of air from the peritoneal cavity into the pleural cavity. This condition predominantly involves the right hemithorax. Hormonal therapy, particularly with gonadotropin-releasing hormone agonists, is a recommended therapeutic approach. Objective: To present a series of catamenial pneumothorax cases. Methods: This retrospective review included cases diagnosed with catamenial pneumothorax between 2021 and 2024. A total of six women were included, with a mean age of 38.5 years (range: 25-46 years; SD = 7.79). All patients presented with dyspnea associated with their menstrual cycle and progressive symptoms of recurrent right-sided pneumothorax. Each underwent a video-assisted thoracoscopic surgery (VATS) procedure for wedge resection to obtain tissue for histopathological diagnosis, along with surgical pleurectomy for definitive management. Results: In all cases, diaphragmatic nodules and diaphragmatic fenestrations were identified intraoperatively. Following wedge resection for histopathological diagnosis, the diaphragmatic defects were repaired using mesh grafts, and surgical pleurectomy was performed via VATS. Histopathologic findings confirmed the presence of endometrial stroma in four cases, while the remaining two showed benign fibromuscular tissue. Postoperatively, all patients received hormonal therapy under gynecologic supervision: gonadotropin-releasing hormone (GnRH) analogues (n = 2), medroxyprogesterone acetate (n = 2), leuprorelin acetate (n = 1), and dienogest (n = 1). Over a mean follow-up duration of 24.83 months (SD = 6.43), no cases of recurrent pneumothorax were reported. Conclusions: VATS surgery is considered the treatment of choice for catamenial pneumothorax. A multidisciplinary approach provides significant benefits to patients. Postoperative hormonal therapy is essential for optimal clinical outcomes and long-term disease control.