Diagnosis and Treatment of Catamenial Pneumothorax: A Systematic Review

Objectives: This study aimed to better characterize the phenomenon of catamenial pneumothorax; evaluate the risk factors, symptoms, and diagnostic modalities; and recommend treatment protocol.

Data sources: We conducted an electronic-based search using PubMed, EMBASE, Ovid MEDLINE, Google Scholar, and Cochrane Central Register of Controlled Trials.

Methods of study selection: The following medical subject heading terms, keywords, and their combinations were used: "catamenial pneumothorax; thoracic endometriosis; pulmonary endometriosis; and pleural endometriosis."

Tabulation, integration, and results: Individual study results were tabulated in each table by outcome of interest. The search produced an initial 404 results. We excluded studies that did not contain cases with catamenial pneumothorax, case studies, and videos. Eighteen studies met our inclusion criteria and were selected, with a total of 490 patients. The prevalence of catamenial pneumothorax of all cases of pneumothorax in women of reproductive age ranges from 7.3% to 36.7%. The diagnosis was made at an older age than that of pelvic endometriosis. The presence of pelvic endometriosis was reported in only 55% of patients with catamenial pneumothorax. Previous pelvic surgeries were mentioned in only a few of the studies, and 52 of 104 cases (50%) had some kind of previous pelvic intervention. Diagnosis was mostly made clinically, with the patients complaining of the typical symptoms of shortness of breath and recurrent chest pain or shoulder pain a day before to 72 hours after menses. Pneumothorax was found mainly in the right lung (456 of 490 cases, 93%). Diaphragmatic endometriosis and/or nodules were observed in 265 of 297 cases (89%). Recurrence rate varied from 14.3% to 55%.

Conclusion: The possibility of endometriosis should be considered in reproductive-aged women with catamenial symptoms of chest pain or shortness of breath. Right pneumothorax and diaphragmatic endometriosis are found in most patients.