User:Aollhoff13/Catamenial Pneumothorax

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Catamenial pneumothorax is a spontaneous pneumothorax that recurs during menstruation, within 72 hours before or after the onset of a cycle. It usually involves the right side of the chest and right lung, and is associated with thoracic endometriosis. A third to a half of patients have pelvic endometriosis as well. Despite this association, CP is still considered to be misunderstood as is endometriosis considered to be underdiagnosed. The lack of a clear cause means that diagnosis and treatment is difficult. The disease is believed to be largely undiagnosed or misdiagnosed, leaving the true frequency unknown in the general population.

Many patients present with chest pain close to their menstrual periods. Surgical exploration can be used in an attempt to visualize the problem; mechanical pleurodesis or hormonal suppressive therapy can also be used. Sometimes, a second surgical look can show fenestrations in the diaphragm. Due to the fact that endometriosis has been attributed to retrograde menstruation, upwards of 90% of women may have an immune deficiency. This prevents clearance of endometrial cells from the peritoneum.

Signs and symptoms can include chest pain that radiates to the shoulder blades, shortness of breath, dizziness, fatigue, and a dry cough that can come with a “crackling” sound upon inhaling. Chest pain requires immediate medical attention.

Although the exact cause is not known, a few theories come from metastatic, hormonal, and anatomical possibilities. The metastatic model proposes that endometrial tissue has migrated from the endometrium to the diaphragm or the pleural space, causing small holes in the diaphragm, allowing air into the pleural space. In the hormonal model, it is believed that prostaglandin F2 causes a narrowing of the bronchioles, the small tubes within the lungs. Narrowing of these can cause the alveoli to rupture which may trap air in the pleural space. In the anatomical model, researchers believe that the absence of the cervical mucous plug, which is normally there during the menstrual cycle, allows air to pass from the genital tract to the pleural space through fenestrations in the diaphragm. Another theory is that hormonal changes that come with the menstrual cycle can cause blebs to spontaneously rupture. Blebs are small blisters/pustules filled with air or fluid and can develop on the lungs.

Treatments can include surgery or hormonal therapy, either separately or together. Both have been used to treat women with this condition, and specifics depend on each patient and each situation. Surgery may be used to excise endometrial tissue from the lungs and pleural space as well as repair damage and holes in the diaphragm. Surgery may also be used to remove blisters (blebs). An additional procedure involves a mesh that is placed over the diaphragm to block any holes that may have been missed in the first surgery. Hormonal therapies can also be used to suppress ovulation. Pleurodesis may also be effective in removing the space between the lung and the chest wall; preventing air build up between these layers.
 * 1) ^ Catamenial pneumothorax. (2019, July 03). Retrieved November 11, 2021
 * 2) ^ Visouli, A., Darwiche, K., Mpakas, A., Zarogoulidis, P., Papagiannis, A., Tsakiridis, K., . . . Zarogoulidis, K. (2012, November). Catamenial pneumothorax: A rare entity? report of 5 cases and review of the literature. Retrieved November 11, 2021
 * 3) ^ Dong, B., Wu, C., Sheng, Y., Wu, B., Ye, G., Liu, Y., . . . Qi, Y. (2021, April 20). Catamenial pneumothorax with bubbling up on the diaphragmatic defects: A case report. Retrieved November 11, 2021