A surgical case of recurrent and worsening catamenial pneumothorax triggered by childbirth

Abstract

A 36-year-old woman, with a history of pelvic endometriosis, was referred for right chest pain on 2 days after an uneventful cesarean section. A chest roentgenogram and computed tomography revealed a right pneumothorax. She had seven prior episodes of pneumothoraxes on the right related to the onset of menstruation, which were treated conservatively with observation.

The insertion of a chest tube into the thoracic cavity was required because pneumothorax was progressing on the 7th day after childbirth. Thoracoscopy revealed the presence of thickening pleura on the right upper lobe and multiple holes in the central tendon of the right diaphragm. Thoracoscopic partial resection of the right upper lobe and diaphragm including the lesions was performed. Postoperatively, she has been symptom-free for two years on hormonal therapy.

The mechanism of catamenial pneumothorax is unclear. It is suggested that the hormonal withdrawal in the postpartum period caused a recurrence and worsening catamenial pneumothorax. It is important to keep in mind that a person with a history of catamenial pneumothorax might develop a serious pneumothorax in the postpartum period.