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J Minim Invasive Gynecol. 2010 Sep-Oct;17(5):593-9. doi: 10.1016/j.jmig.2010.04.011. Epub 2010 Jun 26.

Gynecologic evaluation of catamenial pneumothorax associated with endometriosis.

Author information

1
Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan. kumakiri@juntendo.ac.jp

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.

CONCLUSIONS:

Gynecologic evaluation of catamenial pneumothorax associated with endometriosis is crucial to clarify the unelucidated pathogenesis of the disease.

PMID:
20580323
DOI:
10.1016/j.jmig.2010.04.011
[Indexed for MEDLINE]

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