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Eur J Cardiothorac Surg 2005;27:662-666
© 2005 Elsevier Science NL

Catamenial pneumothorax: optimal hormonal and surgical management

Section of General Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Received 15 September 2004; received in revised form 30 November 2004; accepted 6 December 2004.

^* Corresponding author. Address: Division of Thoracic Surgery, Georgetown University Hospital, 4 PHC, 3800 Reservoir Rd NW, Washington, DC 20007, USA. Tel.: +1 202 444 5045; fax: +1 202 444 3057. (E-mail: mbm5{at}gunet.georgetown.edu).

Objective: To provide further information addressing the etiology, optimal hormonal management and surgical management in catamenial pneumothorax (CP). Methods: We retrospectively analyzed records of all female patients operated on for spontaneous pneumothorax at a university hospital between January 1993 and March 2002. Results: In eight of 24 patients, pneumothoraces were timed with menses. In all, the right side was involved. Seven patients were on hormonal medications pre-operatively and six post-operatively. All six patients taking estrogen/progesterone replacement had recurrences pre-operatively and two of three had recurrences post-operatively while on these medications. No patient suffered a pneumothorax either pre- or post-operatively while taking a gonadotropin releasing hormone agonist (two and three patients, respectively). Intraoperative findings included diaphragmatic implants [5] diaphragmatic fenestrations [4], apical blebs [2] and visceral pleural implants [2]. All pathology was specifically addressed at the time of surgery. Pleural space management included mechanical pleurodesis in seven and pleurectomy with talc insufflation in 1. Follow-up ranged from 27 to 63 months with a mean of 48 months. Three patients developed post-operative recurrences. One was managed without intervention and two required additional procedures. Conclusion: Catamenial pneumothorax is under appreciated, representing up to one-third of women with spontaneous pneumothorax. Hormonal agents that allow for menses are ineffective. Gonadotropin releasing hormone agonists should be considered as part of the pre-operative or post-operative management in high risk patients. Our findings suggest that an additional intervention to augment pleural symphysis at the level of the diaphragm should be performed.

Key Words: Pneumothorax • Spontaneous pneumothorax • Endometriosis • Hormonal therapy • Video assisted thoracic surgery

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