Institutional report - Thoracic non-oncologic Surgical treatment of catamenial pneumothorax: a single centre experience

We retrospectively reviewed our experience with catamenial pneumothorax (CP) in terms of treatment and follow-up. From 1993 to 2008,ten women presented at our department with CP. CP was right-sided in all patients: seven presented diaphragmatic defects including oneendometriosis, five had apical bulla or blebs that in three patients were the only pathological findings. Surgical approach was thoracoscopicwith a muscle-sparing thoracotomy when diaphragmatic defects where present. All patients underwent apical resection and apicalpleurectomy associated in seven cases with diaphragmatic plication and chemical pleurodesis. After surgery nine patients underwenthormonal treatment: three were put on estrogen–progesterone complex treatment and six received gonadotropin-releasing hormone agonist(GnRH agonist). Recurrence rate was 40% and it was significantly correlated with estrogen–progesterone treatment (P-0.005). The meanfollow-up was 52"32 months (range 14–168). At the present time, no recurrence has occurred in all women. Occurrence of CP is oftenunderestimated. At the time of surgery the diaphragm should be carefully inspected for defects andyor endometriosis. Standard pleurodesismay not suffice and we suggest apical resection and apical pleurectomy associated with a diaphragmatic procedure when indicated.Hormonal treatment with GnRH agonist seems to improve the outcome.