Catamenial dyspnea due to recurrent catamenial pneumothorax

Specialty: Respiratory.

• cyclic menstrual pneumothorax
• cyclic dyspnea due to right lung collapse

Why it occurs

• Catamenial pneumothorax secondary to thoracic endometriosis (presence of ectopic endometrial tissue in the visceral or parietal pleura, or on the surface of the diaphragm, which sheds synchronously with menstruation due to fluctuating levels of prostaglandin F2 alpha and estrogens; rupture of endometrial foci or passage of air through pores congenital or acquired diaphragmatic causes the collapse of the right lung in 90-95% of cases)
• Catamenial diaphragmatic fistula without visible implants (passive passage of air from the genital tract through the vagina, uterus, fallopian tubes and peritoneal cavity into the right pleural space during menstruation).

Initial workup

Chest x-ray in forced expiration taken during the menstrual period; High-resolution chest computed tomography (CT) during the luteal or menstrual phase; Diaphragmatic magnetic resonance imaging (MRI) (to accurately identify subcentimeter implants in the diaphragm); Surgical video thoracoscopy (VATS) for direct inspection of the diaphragm and pleura with biopsy collection.

Standard management

• Goserelin — GnRH analog, 3.6 mg subcutaneously every 28 days to suppress ovarian function and promote atrophy of pleural or diaphragmatic endometrial tissue
• Leuprolide — leuprorelin acetate, 3.75 mg intramuscularly every 28 days as an alternative
• Ibuprofen (400-600 mg orally every 8 hours to control analgesics and associated prostaglandins).