IS Case 297: Catamenial pneumothorax

Ahmed El-Sherief, MD

Imaging Sciences URMC 2009
Publication Date: 2009-08-05


Patient is a 41-year old female with respiratory distress.


Right-sided pneumothorax with associated right-sided diaphragmatic endometrial implants.


Catamenial pneumothorax


Thoracic endometriosis syndrome:

  1. catamenial pneumothorax, or
  2. catamenial hemothorax or
  3. catamenial hemoptysis and lung nodules

Catamenial pneumothorax:

  • Mean age at presentation: 3rd or 4th decade of life
  • Involves right lung 95% of time in a recurrent manner

Etiology unknown:

  • Hypothesis 1: spontaneous bleb rupture
  • Hypothesis 2: alveolar rupture secondary to prostaglandin-induced bronchiolar constriction
  • Hypothesis 3: pulmonary air-leak secondary to sloughing of endometrial implants involving visceral pleura
  • Hypothesis 4: congenital or acquired diaphragmatic defect with passage of air from the genital tract through defect


  1. Roth T, Alifano M, Schussler O, Magdaleinat P, Regnard JF. Catamenial pneumothorax: chest X-ray sign and thoracoscopic treatment. Ann Thorac Surg. 2002 Aug;74(2):563-5. PMID: 12173845 [PubMed]
  2. Alifano M, Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge. Ann Thorac Surg. 2006 Feb;81(2):761-9. PMID: 16427904 [PubMed]

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