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Case Report
Catamenial pneumothorax and endometriosis: Report of a rare case
1 Department of Pathology and Molecular Medicine, McMaster University, St Joseph’s Healthcare L222-5, St Luke Wing, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada
2 Department of Radiology, St Joseph’s Healthcare, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada
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Oluwaseun Adelekan
Department of Pathology and Molecular Medicine, McMaster University, St Joseph’s Healthcare L222-5, St Luke Wing, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6,
Canada
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Article ID: 101469Z01OA2024
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Adelekan O, Alowami M, Vasudev P. Catamenial pneumothorax and endometriosis: Report of a rare case. Int J Case Rep Images 2024;15(2):47–52.ABSTRACT
Introduction: Catamenial pneumothorax is a rare condition which is characterized by the recurrent accumulation of air within the pleural cavity without related respiratory diseases. It happens in women of reproductive age, usually within 72 hours before or after onset of menstruation. It occurs in association with characteristic pleural lesions, right-sided location of the pneumothorax, and concomitant thoracic endometriosis. The objective is to report a rare case of thoracic endometriosis in a 35-year-old woman with recurrent catamenial pneumothorax.
Case Report: A 35-year-old female presented with persistent and recurrent right pneumothorax usually occurring immediately after her menstruation. She had no personal history of lung problems, asthma, bronchitis, or any family history of any chronic lung disease. Computed tomography (CT) of the chest showed a large hydropneumothorax on the right side resulting in near-complete collapse of the right lung and mediastinal shift from right to left. The gross specimen comprised the right upper lobe resection of the lung, which weighed 4.9 grams and measured 7.7 cm × 1.5 cm × 1.2 cm. The pleura was mottled brown-gray with adhesions. Histopathologic findings showed pleural endometriosis (pleural endometrial glands and stroma present), consistent with catamenial pneumothorax. Associated pleural adhesions with acute and chronic inflammation and mild emphysematous changes in the lung parenchyma were also noted. Immunohistochemistry with immunostains estrogen receptor (ER) and CD10 highlighted the endometrial glands and stroma which confirmed the diagnosis.
Conclusion: There should be a high index of suspicion of catamenial pneumothorax in women of reproductive age who present with pneumothorax during the perimenstrual period. Adequate sampling of lung wedge resections and careful microscopic examination, followed by confirmation with immunohistochemistry, play important roles in the diagnosis of this rare condition.
Keywords: Catamenial pneumothorax, Endometriosis, Immunohistochemistry
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Acknowledgments
Image credits. Dr. Abdullah Alabousi, MD, FRCPC, Department of Radiology, McMaster University, Hamilton, Ontario.
Author ContributionsOluwaseun Adelekan - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Moaz Alowami - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Pooja Vasudev - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Oluwaseun Adelekan et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
