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Ann Thorac Cardiovasc Surg. 2017 Apr 20;23(2):108-112. doi: 10.5761/ Epub 2016 Aug 10.

Left-Sided Catamenial Pneumothorax with Thoracic Endometriosis and Bullae in the Alveolar Wall.

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Pneumothorax Research Center, Nissan Tamagawa Hosipital, Tokyo, Japan.
Department of Molecular Pharmacology, Graduate School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan.
Department of Surgery, Jinken Clinic, Ebina, Kanagawa, Japan.
Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan.


Catamenial pneumothorax (CP) is generally caused by intraperitoneal air leaking from the uterus into the thoracic cavity via a defect in the endometrial tissue of the diaphragm and is usually detected in the right thorax. We report a case of left-sided CP caused by endometriosis in the visceral pleura and with no abnormal findings in the diaphragm. A 33-year-old female patient presented at the end of a course of low-dose contraceptive pills for pelvic endometriosis, with spontaneous pneumothorax in the left chest. Chest CT revealed a bulla in the left upper lung lobe. The patient underwent partial resection of the lung. Immunohistochemistry confirmed the presence of endometrial stromal tissue in the visceral pleura and confirmed this as the cause of pneumothorax since there were no observable abnormalities in the diaphragm. This case suggests that immunohistochemical examination of patients with spontaneous pneumothorax can detect alternative endometrial lesions.


catamenial pneumothorax; endometriosis; thoracic endometriosis syndrome

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