Imaging Sciences Interesting Cases
Case 297
Ahmed El-Sherief, MD
Clinical Presentation: Patient is a 41-year old female with respiratory distress.
Imaging Findings: Right-sided pneumothorax with associated right-sided diaphragmatic endometrial implants.
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Figure 1: Non-contrast enhanced CT of chest lung window. Right-sided pneumothorax (asterisk). |
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| Figure 2: Non-contrast enhanced CT mediastinal window. Right-sided diaphragmatic endometrial implant (red arrow). |
Diagnosis: Catamenial pneumothorax
Discussion:
Thoracic endometriosis syndrome:
- catamenial pneumothorax, or
- catamenial hemothorax or
- catamenial hemoptysis and lung nodules
Catamenial pneumothorax:
- Mean age at presentation: 3rd or 4th decade of life
- Involves right lung 95% of time in a recurrent manner
Etiology unknown:
- Hypothesis 1: spontaneous bleb rupture
- Hypothesis 2: alveolar rupture secondary to prostaglandin-induced bronchiolar constriction
- Hypothesis 3: pulmonary air-leak secondary to sloughing of endometrial implants involving visceral pleura
- Hypothesis 4: congenital or acquired diaphragmatic defect with passage of air from the genital tract through defect
References:
- Roth T, Alifano M, Schussler O, Magdaleinat P, Regnard JF. Catamenial pneumothorax: chest X-ray sign and thoracoscopic treatment. Ann Thorac Surg. 2002 Aug;74(2):563-5. PMID: 12173845 [PubMed]
- Alifano M, Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge. Ann Thorac Surg. 2006 Feb;81(2):761-9. PMID: 16427904 [PubMed]