Gynecologic Evaluation of Catamenial Pneumothorax Associated with Endometriosis

Kumakiri, Jun; Kumakiri, Yuko; Miyamoto, Hideaki; Kikuchi, Iwaho; Arakawa, Atsushi; Kitade, Mari; Takeda, Satoru

doi:10.1016/j.jmig.2010.04.011

« Previous Next »The Journal of Minimally Invasive Gynecology
Volume 17, Issue 5 , Pages 593-599, September 2010

Gynecologic Evaluation of Catamenial Pneumothorax Associated with Endometriosis

Jun Kumakiri, MD
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
- Corresponding author: Jun Kumakiri, MD, Departments of Obstetrics and Gynecology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan.
Yuko Kumakiri, MD
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
Hideaki Miyamoto, MD
- Department of Respiratory Surgery, Juntendo University School of Medicine, Tokyo, Japan
Iwaho Kikuchi, MD
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
Atsushi Arakawa, MD
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
Mari Kitade, MD
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
Satoru Takeda, MD
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan

Received 26 November 2009; accepted 23 April 2010. published online 28 June 2010.

Abstract

Study Objective

To assess the pathogenesis of catamenial pneumothorax associated with endometriosis from a gynecologic perspective.

Design

Retrospective study (Canadian Task Force classification II–2).

Setting

University hospital.

Patients

Eleven patients with clinically suspected catamenial pneumothorax due to frequently recurrent pneumothorax who underwent thoracoscopy between September 2003 and February 2007 at our hospital.

Intervention

Video-assisted thoracoscopy.

Measurements and Main Results

Episodes of pneumothorax, coexistence of intrapelvic endometriosis, classification of intrathoracic lesions according to the appearance of pelvic endometriosis using the revised American Society of Reproductive Medicine (re-ASRM) classification, and histopathologic findings in intrathoracic specimens were assessed. A total of 38 episodes of pneumothorax, all on the right side, were documented in 11 patients with catamenial pneumothorax. Median (range) patient age at the initial pneumothorax was 42 (29–47) years. The re-ASRM score in 6 patients in whom pelvic endometriosis was directly observed at laparoscopy and laparotomy was 56 (18–96). We postoperatively reviewed videotape recordings of video-assisted thoracoscopy, and observed superficial thoracic diaphragmatic lesions classified as red (n = 5), black (n = 8), and white (n = 9) with fenestration according to the re-ASRM classifications for pelvic endometriosis. Tissue associated with endometriosis was detected at histopathologic analysis of resected diaphragmatic lesions in 9 patients. No endometriosis was identified at histopathologic analysis of visceral pleural lesions in 7 patients who underwent lung resection.