Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia.
Redland Bay Hospital, Brisbane, Qld, Australia.
Heart Lung Circ. 2019 Jun;28(6):850-857. doi: 10.1016/j.hlc.2019.01.012. Epub 2019 Feb 22.
Catamenial pneumothorax (CP) is an unusual condition affecting premenopausal women and commonly misdiagnosed as simple pneumothorax. It is characterised by its recurrence between the day before and within 72 hours after the onset of menstruation. It has been associated with thoracic endometriosis but the aetiology is not well understood and there is no unified agreement for its optimal management. The aim of this study is to determine the incidence of CP in surgical patients and the results of their treatment.
Females between the ages of 30 to 50 years with a diagnosis of pneumothorax, admitted for surgery over a 10-year period in four different hospitals were retrospectively reviewed for evidence of CP. An audit of surgical and medical management of the patients with CP and their short to midterm outcomes was performed in addition to a systemic review of the literature on CP.
A total of 120 premenopausal female patients with a diagnosis of pneumothorax were admitted for Video Assisted Thoracoscopic (VAT) surgery and five women (4.1%) with a mean age of 42.6 years were diagnosed to have CP through surgical and histological findings. The first case was diagnosed 5 years ago and the last three within recent 12 months after the changes in surgical practices of inspecting diaphragmatic surface in suspected cases of CP. Four patients underwent diaphragmatic plication and one patient had a pleural biopsy. All patients underwent talc pleurodesis and hormone therapy in the postoperative period. Short to midterm (mean follow-up period of 25.2 months) results of the patients with CP were encouraging.
It is possible that many of the cohort of premenopausal female patients presenting with recurrent pneumothorax are misdiagnosed as spontaneous pneumothorax (SP) because routine inspection of the diaphragmatic surface is not often performed. A thorough menstrual history and its temporal relation to pneumothorax onset should be assessed on every woman presenting with recurrent pneumothorax and intraoperative exploration of diaphragmatic surface should be performed in the patients with high suspicion of CP as the patients diagnosed with CP have a good outcome with surgery and hormone therapy.
月经性气胸（CP）是一种影响围绝经期前女性的罕见病症，常被误诊为单纯性气胸。其特征是在月经开始前一天至 72 小时内反复发作。它与胸腔内子宫内膜异位症有关，但病因尚不清楚，其最佳治疗方法也没有统一的共识。本研究旨在确定手术患者中 CP 的发病率及其治疗结果。
回顾性分析了在四家不同医院接受手术治疗的年龄在 30 至 50 岁之间的女性气胸患者，以确定 CP 的诊断。对 CP 患者的手术和医疗管理以及他们的短期至中期结果进行了审核，并对 CP 的文献进行了系统性回顾。
共收治了 120 例诊断为气胸的围绝经期前女性患者，接受电视辅助胸腔镜 (VAT) 手术，其中 5 例（4.1%）平均年龄为 42.6 岁的女性通过手术和组织学发现诊断为 CP。首例病例诊断于 5 年前，最近 12 个月内诊断出 3 例，这是在对 CP 疑似病例检查膈肌表面的手术操作发生变化之后。4 例患者行膈肌折叠术，1 例患者行胸膜活检术。所有患者术后均行滑石粉胸膜固定术和激素治疗。CP 患者的短期至中期（平均随访时间为 25.2 个月）结果令人鼓舞。
许多因复发性气胸就诊的围绝经期前女性患者可能被误诊为自发性气胸（SP），因为常规检查膈肌表面并不常见。对于每一位复发性气胸患者，都应详细询问月经史，并评估其与气胸发作的时间关系。对于高度怀疑 CP 的患者，应在术中探查膈肌表面。对于被诊断为 CP 的患者，手术和激素治疗效果良好。
