User:Olivetabasco/Catamenial pneumothorax
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[edit]Background
[edit]Catamenial pneumothorax is defined as at least two episodes of recurrent pneumothorax corresponding with menstruation. It was first described in 1858 when a woman presented with 12 episodes of right-sided pneumothorax over 1 year, recurring monthly with menstruation. Thoracotomy revealed thoracic endometriosis. [1]
Endometriosis is defined as endometrial tissue that has implanted outside of the uterus. Mechanisms include retrograde menstruation resulting in abdomino-pelvic spread, blood-borne or lymphatic spread and deposition, and metaplasia.[2]
Thoracic endometriosis is the most common non-abdominal site of involvement and is also the primary risk factor for catamenial pneumothorax.[3] Catamenial pneumothorax is the primary clinical presentation of thoracic endometriosis, and symptoms include chest or shoulder pain, cough, dyspnea, and shortness of breath.[4]
Pathophysiology
[edit]Endometrial tissue attaches within the thoracic cavity, forming chocolate-like cysts. Generally the parietal pleura is involved, but the lung itself, the visceral layer, the diaphragm, and more rarely the tracheobronchial tree may also be afflicted. The mechanism through which endometrial tissue reaches the thorax remains unclear.
Nearly 90% of cases occur on the right hemithorax, a phenomenon thought to potentially be due to the direction of flow of retroperitoneal fluid[5]. Peritoneal flow occurs in a clockwise pattern, which could likely explain the tendency for catamenial pneumothoraces to be right-sided[6][7]. Defects in the diaphragm, which are found often in affected individuals, could provide an entry path, as could microembolization through pelvic veins. Such diaphragmatic defects may be either congenital or acquired.
The cysts can release blood; the endometrial cyst "menstruates" in the lung. Endometrial cells undergo structural changes during the secretory phase of the menstrual cycle, in a process called decidualization. Decidualized pleural endometrial implants can disrupt the pleura and lead to pneumothorax (and hemothorax)[8].
Diagnosis and Treatment
[edit]Clinical diagnosis can be made based on history and imaging, while the gold standard for definitive diagnosis remains video-assisted thoracoscopic surgery (VATS), which allows not only the visualization of the lesion, but also surgical treatment via cauterization of the ectopic endometrial tissue. Special staining under a microscope or utilizing a cell marker, such as PAX8, can be used to positively identify endometrial stroma [4].
Non-surgical treatment includes pharmacological treatment via continuous oral contraceptive therapy to avoid cyclical bleeding with monthly menstruation. Oral contraceptives appear to be preferable for patients due to fewer negative side effects than treatment with GnRH agonist therapy, which can lead to hypoestrogenic effects including osteoporosis, resulting in discontinuation of therapy and thus a higher likelihood of recurrence of catamenial pneumothorax [4].
References
[edit]- ^ Maurer, Elmer R. (1958-12-13). "CHRONIC RECURRING SPONTANEOUS PNEUMOTHORAX DUE TO ENDOMETRIOSIS OF THE DIAPHRAGM". Journal of the American Medical Association. 168 (15): 2013. doi:10.1001/jama.1958.63000150008012c. ISSN 0002-9955.
- ^ Burney, Richard O.; Giudice, Linda C. (2012-09). "Pathogenesis and pathophysiology of endometriosis". Fertility and Sterility. 98 (3): 511–519. doi:10.1016/j.fertnstert.2012.06.029. PMC 3836682. PMID 22819144.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: PMC format (link) - ^ Rousset-Jablonski, C.; Alifano, M.; Plu-Bureau, G.; Camilleri-Broet, S.; Rousset, P.; Regnard, J.-F.; Gompel, A. (2011-09-01). "Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors". Human Reproduction. 26 (9): 2322–2329. doi:10.1093/humrep/der189. ISSN 0268-1161.
- ^ a b c Hirata, Tetsuya; Koga, Kaori; Osuga, Yutaka (2020). "Extra-pelvic endometriosis: A review". Reproductive Medicine and Biology. 19 (4): 323–333. doi:10.1002/rmb2.12340. ISSN 1447-0578. PMC 7542014. PMID 33071634.
{{cite journal}}: CS1 maint: PMC format (link) - ^ Joseph, Jos; Sahn, Steven A. (1996-02). "Thoracic endometriosis syndrome: New observations from an analysis of 110 cases". The American Journal of Medicine. 100 (2): 164–170. doi:10.1016/S0002-9343(97)89454-5.
{{cite journal}}: Check date values in:|date=(help) - ^ Meyers, Morton A. (1970-06). "The Spread and Localization of Acute Intraperitoneal Effusions". Radiology. 95 (3): 547–554. doi:10.1148/95.3.547. ISSN 0033-8419.
{{cite journal}}: Check date values in:|date=(help) - ^ DRYE JC. Intraperitoneal pressure in the human. Surg Gynecol Obstet. 1948 Oct;87(4):472-5. PMID: 18119801.
- ^ van der Merwe, E.; Schuurmans, M.M.; de Kock, F.; Siebert, I.; Wright, C.; Bolliger, C.T. (2005). "Bloodstained Pleural Effusion in a 38-Year-Old Non-Smoking Female". Respiration. 72 (1): 101–104. doi:10.1159/000083410. ISSN 0025-7931.