2013 Volume 27 Issue 6 Pages 693-698
We report two cases of catamenial pneumothorax treated by video-assisted thoracoscopic surgery. The first case was a 36-year-old woman who developed right pneumothorax and came to our hospital. Thoracoscopic surgery was performed in the menstrual period, and revealed multiple perforations of the diaphragm, so we performed the diaphragm reefing procedure. Postoperative hormone therapy was initiated and amenorrhea was maintained, but she developed recurrence of pneumothorax 6 months after surgery. There was continuous air leakage after thoracic drainage, so we performed re-operation. Thoracoscopy showed a bulla in the middle lobe of the right lung that was not seen during the first surgery, and we performed resection. The second case was a 40-year-old woman who developed right pneumothorax in the menstrual period, and came to our hospital. There was continuous air leakage after thoracic drainage. We performed thoracoscopic surgery, which revealed multiple perforations of the diaphragm and a bulla in the middle lobe of the right lung. We performed partial resection of the diaphragm in the perforated area and bulla resection. In both cases, we could not histologically identify endometrial tissue in the resected specimen. Although no clear criterion have been established about the timing of surgery for catamenial pneumothorax, when we encounter a case of catamenial pneumothorax with prolonged air leakage, an operation should performed immediately without persisting with a histological diagnosis because there is a possibility of an emphysemal lesion or rupture.
