*Catamenial Pneumothorax DOI: http://dx.doi.org/10.5772/intechopen.82564*

*Pneumothorax*

2010;**89**:183-188

Rzyman W. Catamenial pneumothorax—A review of the literature. Kardiochirurgia i

Surgery. 1999;**68**:1413-1414

[20] Majak P, Langebrekke A, Hagen OM, Qviqstad E. Catamenial

manifestations—A multidisciplinary challenge. Pneumonologia i Alergologia

[21] Roth T, Alifano M, Schussler O, Magdaleinat P, Regnard JF. Catamenial pneumothorax: Chest X-ray sign and thoracoscopic treatment. The Annals of Thoracic Surgery. 2002;**74**:563-565

[22] Bagan P, Le Pimpec Barthes F, Assouad J, et al. Catamenial

pneumothorax: Retrospective study of surgical treatment. The Annals of Thoracic Surgery. 2003;**75**:378-381

[23] Ciriaco P, Negri G, Libretti L, et al. Surgical treatment of catamenial pneumothorax: A single centre

experience. Interactive Cardiovascular and Thoracic Surgery. 2009;**8**:349-352

[24] Visouli AN, Darwiche K, Mpakas A, et al. Catamenial pneumothorax: A

pneumothorax, clinical

Polska. 2011;**79**:347-350

2014;**20**:202-206

the association between clinical presentation and thoracic pathology based on thoracoscopic findings in 110 patients. Medicine (Baltimore).

rare entity? Report of 5 cases and review of the literature. Journal of Thoracic

[25] Schoenfeld A, Ziv E, Zeelel Y, et al. Catamenial pneumothorax—A literature review and report of an unusual case. Obstetrical & Gynecological Survey. 1986;**41**:20-24

[26] Blanco S, Hernando F, Gómez A, et al. Catamenial pneumothorax caused by diaphragmatic endometriosis. The Journal of Thoracic and Cardiovascular

Surgery. 1998;**116**:179-180

Chest. 1986;**89**:378-382

Proceedings. 1974;**49**:98-101

Surgery. 2011;**92**:322-326

Disease. 2014;**6**:S448-S460

Surgery. 1996;**62**:585-586

[29] Alifano M, Legras A, Rousset-Jablonski C, et al. Pneumothorax recurrence after surgery in women: Clinicopathologic characteristics and management. The Annals of Thoracic

[30] Visouli AN, Zarogoulidis K, Kougioumtzi I, et al. Catamenial pneumothorax. Journal of Thoracic

[31] Laws HL, Fox LS, Younger JB. Bilateral catamenial pneumothorax. Archives of Surgery. 1977;**112**:627-628

[32] Van Schil PE, Vercauteren SR, Vermeire PA, et al. Catamenial pneumothorax caused by thoracic endometriosis. The Annals of Thoracic

[33] Downey DB, Towers MJ, Poon PY, et al. Pneumoperitoneum with catamenial pneumothorax. AJR. American Journal of Roentgenology. 1990;**155**:29-30

[27] Nakamura H, Konishiike J, Sugamura A, et al. Epidemiology of spontaneous pneumothorax in women.

[28] Shearin RP, Hepper NG, Payne WS. Recurrent spontaneous pneumothorax concurrent with menses. Mayo Clinic

Disease. 2012;**4**:17-31

[17] Marjański T, Sowa K, Czapla A,

Torakochirurgia Polska. 2016;**13**:117-121

[18] Cowl CT, Dunn WF, Deschamps C. Visualisations of diaphragmatic

fenestration associated with catamenial pneumothorax. The Annals of Thoracic

[19] Haga T, Kurihara M, Kataoka H, Ebana H. Clinical-pathological

findings of catamenial pneumothorax: Comparison between recurrent cases and nonrecurrent cases. Annals of Thoracic and Cardiovascular Surgery.

**52**

[34] Jablonski C, Alifano M, Regnard JF, et al. Pneumoperitoneum associated with catamenial pneumothorax in women with thoracic endometriosis. Fertility and Sterility. 2009;**91**:930. e19-930.e22

[35] Grunewald RA, Wiggins J. Pulmonary endometriosis mimicking acute abdomen. Postgraduate Medical Journal. 1988;**64**:865-866

[36] Nezhat C, King LP, Paka C, et al. Bilateral thoracic endometriosis affecting the lung and diaphragm. JSLS. 2012;**16**:140-142

[37] Andrade-Alegre R, González W. Catamenial pneumothorax. Journal of the American College of Surgeons. 2007;**205**:724

[38] Alifano M, Magdeleinat P, Regnard JF. Catamenial pneumothorax: Some commentaries. The Journal of Thoracic and Cardiovascular Surgery. 2005;**129**:1199

[39] Morcos M, Alifano M, Gompel A, et al. Life-threatening endometriosisrelated hemopneumothorax. The Annals of Thoracic Surgery. 2006;**82**:726-729

[40] Suwatanapongched T, Boonsarngsuk V, Amornputtisathaporn N, Leelachaikul P. Thoracic endometriosis with catamenial haemoptysis and pneumothorax: Computed tomography findings and long-term follow-up after danazol treatment. Singapore Medical Journal. 2015;**56**:e120-e123

[41] Triponez F, Alifano M, Bobbio A, et al. Endometriosis-related spontaneous diaphragmatic rupture. Interactive Cardiovascular and Thoracic Surgery. 2010;**11**:485-487

[42] Slasky BS, Siewers RD, Lecky JW, et al. Catamenial pneumothorax: The roles of diaphragmatic defects and endometriosis. AJR. American Journal of Roentgenology. 1982;**138**:639-643

[43] Bobbio A, Carbognani P, Ampollini L, et al. Diaphragmatic laceration, partial liver herniation and catamenial pneumothorax. Asian Cardiovascular & Thoracic Annals. 2007;**15**:249-251

[44] Pryshchepau M, Gossot D, Magdeleinat P. Unusual presentation of catamenial pneumothorax. European Journal of Cardio-Thoracic Surgery. 2010;**37**:1221

[45] Picozzi G, Beccani D, Innocenti F, et al. MRI features of pleural endometriosis after catamenial haemothorax. Thorax. 2007;**62**:744

[46] Rousset P, Rousset-Jablonski C, Alifano M, Mansuet-Lupo A, Buy JN, Revel MP. Thoracic endometriosis syndrome: CT and MRI features. Clinical Radiology. 2014;**69**(3):323-330

[47] Attaran M, Falcone T, Goldberg J. Endometriosis: Still tough to diagnose and treat. Cleveland Clinic Journal of Medicine. 2002;**69**:647-653

[48] Hagneré P, Deswarte S, Leleu O. Thoracic endometriosis: A difficult diagnosis. Revue des Maladies Respiratoires. 2011;**28**:908-912

[49] Larraín D, Suárez F, Braun H, Chapochnick J, Diaz L, Rojas I. Thoracic and diaphragmatic endometriosis: Single-institution experience using novel, broadened diagnostic criteria. Journal of the Turkish-German Gynecological Association. 2018;**19**:116-121

[50] Suzuki S, Yasuda K, Matsumura Y, et al. Left-side catamenial pneumothorax with endometrial tissue on the visceral pleura. The Japanese Journal of Thoracic and Cardiovascular Surgery. 2006;**54**:225-227

[51] Makhija Z, Marrinan M. A case of Catamenial pneumothorax with diaphragmatic fenestrations. The Journal of Emergency Medicine. 2012;**43**:e1-e3

[52] Fonseca P. Catamenial pneumothorax: A multifactorial etiology. The Journal of Thoracic and Cardiovascular Surgery. 1998;**116**:872-873

[53] Kumakiri J, Kumakiri Y, Miyamoto H, et al. Gynecologic evaluation of catamenial pneumothorax associated with endometriosis. Journal of Minimally Invasive Gynecology. 2010;**17**:593-599

[54] Kronauer CM. Images in clinical medicine. Catamenial pneumothorax. The New England Journal of Medicine. 2006;**355**:e9

[55] Baysungur V, Tezel C, Okur E, Yilmaz B. Recurrent pneumothorax diagnosed as catamenial after videothoracoscopic examination of the pleural cavity. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2011;**21**:e81-ee3

[56] Mikroulis DA, Didilis VN, Konstantinou F, et al. Catamenial pneumothorax. The Thoracic and Cardiovascular Surgeon. 2008;**56**:374-375

**55**

**Chapter 5**

Treatment

literature at its current state of evidence.

*Khalid Amer*

**1. Introduction**

**Abstract**

Controversies in Pneumothorax

Surgical intervention either by video-assisted thoracoscopic surgery (VATS) or open procedure proved its worth in reducing the incidence of recurrence in pneumothorax. However, many controversies surround the management of this common medical condition. Despite advances in knowledge and technology, chest physicians and surgeons could not be more divisive about the management of pneumothorax. There are no two thoracic surgical centres and possibly no two surgeons within the same hospital that agree on the management of the different aspects of pneumothorax. The variability in reported outcomes and the paucity of published multicentre randomised controlled trials (RCT) highlight the need for further studies investigating the best options for pneumostasis and pleurodesis. This chapter aims at discussing some of these controversies and reviews the

**Keywords:** pneumothorax, video-assisted thoracic surgery, thoracotomy, pleurodesis, air leak, surgical emphysema, intercostal drain, COPD

The Red Indians knew that the North American buffalo had a single pleural cavity. A single arrow to the chest was enough to collapse both lungs and expedite the death of the beast. On the other hand, the elephant is unique insofar as it is the only mammal whose pleural space is obliterated by connective tissue. This natural pleurodesis has been known for over 300 years but only recently explained [1]. Apparently, the elephant is the only mammal that can remain submerged far below the surface of the water while snorkelling. It is intriguing though that the foetal elephant has normal pleural spaces that obliterate later in gestation [2]. Humans are slightly luckier; they enjoy two pleural spaces separated by mediastinal structures; if one lung collapses, the other one sustains life. However, there are reports in the literature of some patients with pleuro-pleural congenital communications, presenting with simultaneous bilateral pneumothoraces, the so-called buffalo chest [3].

Humans collapse their lungs frequently, and the different ways we deal with this common condition match its frequency. There is bound to be differences in opinion, and the multicentre randomised controlled trials (RCT) have not come up with a solid protocol to guide management. There was no general agreement on therapy when Ruckley and McCormac of the Royal Infirmary of Edinburgh described the management of pneumothorax in 1966 [4]. There is no agreement at our present time still, despite the technological advances in our knowledge and the available randomised controlled trials. We could not agree more with Robert Cerfolio et al. on
