Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China.
BMC Womens Health. 2021 Apr 20;21(1):167. doi: 10.1186/s12905-021-01318-0.
Catamenial pneumothorax is characterized by spontaneous recurring pneumothorax during menstruation, which is a common clinical manifestation of thoracic endometriosis syndrome. There are still controversies about its pathogenesis.
A 43-year-old woman with a history of endometriosis came to our hospital due to recurring pneumothorax during menstruation. Uniportal Video-assisted Thoracoscopic Surgery (VATS) exploration was performed on the eve of menstruating. We thoroughly explored the diaphragm, visceral and parietal pleura: The lung surface was scattered with yellowish-brown implants; no bullae were found; multiple diaphragmatic defects were found on the dome. And surprisingly, we caught a fascinating phenomenon: Bubbles were slipping into pleural cavity through diaphragmatic defects. We excised the diaphragmatic lesions and wedge resected the right upper lung lesion; cleared the deposits and flushed the thoracic cavity with pure iodophor. Diaphragmatic lesions confirmed the presence of endometriosis, and interestingly enough, microscopically, endometrial cells were shedding with impending menses. After a series of intraoperative operations and postoperative endocrine therapy, the disease did not recur after a period of follow-up.
We have witnessed the typical signs of catamenial pneumothorax at the accurate timing: Not only observed the process of gas migration macroscopically, but also obtained pathological evidence of diaphragmatic periodic perforation microscopically, which is especially precious and confirms the existing theory that retrograde menstruation leads to diaphragmatic endometriosis, and the diaphragmatic fenestration is obtained due to the periodic activities of ectopic endometrium.
月经性气胸的特征是在月经期间自发性反复发作气胸，这是胸子宫内膜异位症综合征的常见临床表现。其发病机制仍存在争议。
一位 43 岁的女性，有子宫内膜异位症病史，因月经期间反复发作气胸来我院就诊。在月经来潮前夕，我们进行了单孔电视辅助胸腔镜手术（VATS）探查。我们彻底探查了膈肌、内脏和壁层胸膜：肺表面散布着黄棕色的植入物；未发现大疱；穹窿部有多个膈肌缺陷。令人惊讶的是，我们捕捉到了一个迷人的现象：气泡通过膈肌缺陷滑入胸腔。我们切除了膈肌病变，并楔形切除右上肺病变；清除沉积物并用纯碘伏冲洗胸腔。膈肌病变证实存在子宫内膜异位症，有趣的是，显微镜下，随着月经的临近，子宫内膜细胞正在脱落。经过一系列术中操作和术后内分泌治疗，在一段时间的随访后，疾病没有复发。
我们在准确的时间见证了月经性气胸的典型征象：不仅宏观上观察到了气体迁移的过程，还微观上获得了膈肌周期性穿孔的病理证据，这尤其珍贵，并证实了现有的逆行月经导致膈肌子宫内膜异位症的理论，以及由于异位子宫内膜的周期性活动而获得膈肌孔。
