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Cited by 127Pleural and Pulmonary DiseasesPneumothorax, Barotrauma, EmphysemaNeurosurgical Procedures and Complications

Catamenial pneumothorax: Optimal hormonal and surgical management

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MARSHALL, M, AHMED, Z, KUCHARCZUK, J, KAISER, L, SHRAGER, J·2005·European Journal of Cardio-Thoracic Surgery
DOI 10.1016/j.ejcts.2004.12.047
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Abstract

OBJECTIVE: To provide further information addressing the etiology, optimal hormonal management and surgical management in catamenial pneumothorax (CP). METHODS: We retrospectively analyzed records of all female patients operated on for spontaneous pneumothorax at a university hospital between January 1993 and March 2002. RESULTS: In eight of 24 patients, pneumothoraces were timed with menses. In all, the right side was involved. Seven patients were on hormonal medications pre-operatively and six post-operatively. All six patients taking estrogen/progesterone replacement had recurrences pre-operatively and two of three had recurrences post-operatively while on these medications. No patient suffered a pneumothorax either pre- or post-operatively while taking a gonadotropin releasing hormone agonist (two and three patients, respectively). Intraoperative findings included diaphragmatic implants [5] diaphragmatic fenestrations [4], apical blebs [2] and visceral pleural implants [2]. All pathology was specifically addressed at the time of surgery. Pleural space management included mechanical pleurodesis in seven and pleurectomy with talc insufflation in 1. Follow-up ranged from 27 to 63 months with a mean of 48 months. Three patients developed post-operative recurrences. One was managed without intervention and two required additional procedures. CONCLUSION: Catamenial pneumothorax is under appreciated, representing up to one-third of women with spontaneous pneumothorax. Hormonal agents that allow for menses are ineffective. Gonadotropin releasing hormone agonists should be considered as part of the pre-operative or post-operative management in high risk patients. Our findings suggest that an additional intervention to augment pleural symphysis at the level of the diaphragm should be performed.

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  • No difference in efficacy has been demonstrated between GnRH analogs and alternative medications for TES.

    “No difference in efficacy has been demonstrated between these medications.53,54”

    From Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management (2019) · cites this paper as [53]

    The Hormonal manipulation section reports recurrences during hormone-replacement therapy but none while patients took a GnRH agonist. The Discussion says therapies that allow menses do not prevent catamenial pneumothorax, whereas GnRH agonist therapy appears to suppress it. The paper therefore makes a contrary efficacy distinction, although it does not report a formal comparative trial. (LLM, conf=0.86)

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  • No hormonal treatment has shown superiority for post-operative management of TES.

    “No hormonal treatment has shown superiority, and ultimately it is the patient’s choice [ 95 ].”

    From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [95]

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Authors
MARSHALL, M., AHMED, Z., KUCHARCZUK, J., KAISER, L., & SHRAGER, J.
Affiliations
University of Pennsylvania (US)
Corresponding author
MARSHALL, M
ORCID
Venue
European Journal of Cardio-Thoracic Surgery
Publisher
Oxford University Press (OUP)
Published
2005-04
Volume
27
Issue
4
Pages
662-666
ISSN
1010-7940 (ISSN-L)
DOI
10.1016/j.ejcts.2004.12.047
OpenAlex
W2127690660
Cited by
127
References
17
Citations by year
2026: 4 · 2025: 5 · 2024: 9 · 2023: 4 · 2022: 7 · 2021: 8 · 2020: 9 · 2019: 13 · 2018: 6 · 2017: 6 · 2016: 3 · 2015: 2 · 2014: 5 · 2013: 8 · 2012: 4
FWCI
5.06
Type
journal article
Language
en
Open access
Locations
  • European Journal of Cardio-Thoracic Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pleural and Pulmonary Diseases
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pneumothorax, Barotrauma, Emphysema
  • Health Sciences › Medicine › Neurology › Neurosurgical Procedures and Complications
Keywords
catamenial pneumothorax, spontaneous pneumothorax, GnRH agonist, diaphragmatic fenestrations, pleurodesis, postoperative recurrence, women
MeSH terms
Adult, Endometriosis, Female, Humans, Gonadotropin-Releasing Hormone, Menstruation, Pneumothorax, Recurrence, Retrospective Studies, Hormone Replacement Therapy, Thoracic Surgery, Video-Assisted

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