Case Report

Catamenial Pneumothorax with Umbilical and Diaphragmatic Endometriosis: A Case Report and Review of the Literature

Authors: Vichaya Arunthari, MD, Bernd-Uwe Sevin, MD, PhD, Murli Krishna, MD, Margaret M. Johnson, MD


A 44-year-old female presented with a history of recurrent right-sided pneumothoraces, uterine fibroids, and a palpable lump in her navel. Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) and resection of the umbilical nodule was performed. Intraoperative inspection of the right hemidiaphragm revealed adherent brownish-blue nodules without any associated diaphragmatic defects and a similar-appearing nodule at the umbilicus. She had no symptoms of pelvic endometriosis, nor did surgical exploration reveal any. Her postoperative course was uneventful and she denied recurrent pneumothorax at 12-month followup. Recurrent pneumothoraces in women of a reproductive age should raise the suspicion of thoracic endometriosis. Failure to establish the diagnosis prevents appropriate curative interventions.

Key Points

* The diagnosis of thoracic endometriosis is often delayed because of lack of awareness of the disorder and failure to recognize the temporal relationship of signs and symptoms with menses.

* Typically, but not universally, thoracic endometriosis occurs in association with pelvic endometriosis.

* Total abdominal hysterectomy with bilateral salpingo-oophorectomy is generally curative for thoracic manifestations of endometriosis.

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