2005 Volume 19 Issue 4 Pages 576-580
A 45-year-old woman with dyspnea and shoulder pain was admitted to our center. She had developed the symptoms at the time of menstruation, suggesting catamenial pneumothorax. She was treated with GnRH analogue and discharged with a good response. She had recurrent right pneumothorax three months later, although she had been taking GnRH analogue and didn't experience regular menstruation. A right thoracoscopy was performed. There were two fenestrations and some thin parts in the right diaphragm. Partial resection of the diaphragm was performed under VATS. Microscopic examination revealed endometriosis in the resected diaphragm. She has had no pneumothorax for 14 months since the operation, without treatment by GnRH analogue.
We studied 45 Japanese reports of catamenial pneumothorax since 2000. Almost catamenial pneumothorax have diaphragmatic lesions and therefore must relate to them. Left diaphragmatic lesion may be expected spontaneous closure for adhesion of omentum and treated with hormonal therapy at first, whereas right diaphragmatic lesion can't be expected spontaneous closure and should be performed VATS for first choice.
