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Friday, January 18, 2008

Catamenial Pneumothorax

A GYN Disease with Secondary Pulmonary Symptoms

Dr. Glynis D. Wallace
Author: Living With Lung and Colon
Endometriosis: Catamenial Pneumothorax\

Lung endometriosis refers to tissue outside
the uterus where women carry
babies, attached to the lung. The term
‘Catamenial Pneumothorax’ describes
collapse of the lung during menstruation.
The first reported cases of this disease
were in the 1930’s. Menstrual bleeding
from a lung tumor associated
with endometriosis was by Schwarz
in 1938. A laboratory investigation
by Hobbs and Bortnick 1940 was able
to produce pulmonary endometriosis in
rabbits by intravenous infusion of endometrial
tissue suspension. Bungeler
and associates in 1939 reported autopsy
findings of three small nodules of
endometriosis on the right upper
pleural surface in a 42-year-old woman.
Nicholson in 1951 was the first to
report histologically proven endometriosis
in a clinical case of recurrent
hemorrhagic pleural effusion. Many
cases of endometriosis have been
reported within the thorax in various
sites: lung parenchyma, pleura,
diaphragm, myocardium and bronchial
tree. This has been referred to as Thoracic,
Pulmonary, Extrapelvic and
Lung Endometriosis. This disease
is considered to be extremely rare,
but actually it is, under recognized and
under diagnosed.
Pioneers of Thoracic Endometriosis:
Author Year Age Loc Symptoms Proof Endo
Bungeler et al. 1939 42 Rt None, autopsy material Micro --
Nicholson 1951 23 Rt Hemothorax, recurrent Micro Yes
Charles 1957 33 Rt Hemothorax, recurrent None Yes
Ripstein et al. 1959 24 Rt Hemothorax, recurrent Micro Yes
Williams et al. 1962 26 Rt Hemothorax None Yes
Brews 1954 39 Rt Pleural effusion, ascites Micro Yes
Maurer et al. 1958 35 Rt Pneumothorax Micro Yes
Skobel 1963 39 Rt Hemothorax Micro Yes
McSwain et al 1964 30 Rt Pneumothorax, recurrent -- Yes
Schwarz 1938 - - Hemoptysis, cyclic None --
Lattes et al. 1956 34 Rt Hemoptysis during menses Micro No
Fleishman et al. 1959 39 Lft Hemoptysis during menses Radio No
Sturzennegger 1960 52 Rt None, x-ray finding Micro --
Mobbs et al. 1963 31 Rt None, x-ray finding Micro --
Kishkovsky et al 1963 34 Rt Hemoptysis during menses Radio --
Rodman et al. 1962 26 1Ab Lft Hemoptysis during menses Micro --
Felson et al. 1960 46 - RV Pleural effusion Microscopic

Catamenial pneumothorax is a
condition of collapsed lung occurring in
conjunction with menstrual periods
(catamenial refers to menstruation),
believed to be caused primarily by
endometriosis of the pleura
(the membrane surrounding the lung).

Catamenial Hemopneumothorax is
when endometrial cells attaches to the
lung release blood which accumulates to
large levels, and air moves in through
fenestrations in the diaphragm by an
unknown mechanism causing the lung to

Catamenial Hemothorax is the
accumulation of blood without lung

Catamenial Hemoptysis: Coughing up
blood from the respiratory tract during
menstruation because of intrathoracic
endometriosis. Endometrial cells have
moved into the tracheo-bronchial tree

1 Brews, A.: Endometriosis of Diaphragm and
Meig’s Syndrome, Proc. Roy. Soc. Med. 47:
461, 1954.
2 Bungeler, W., and Silveira, D. F.: Quoted in
Lattes et al.”
3 Charles, D.: Endometriosis and Hemorrhagic
Pleural Effusion, Obst. & Gynec. 10: 309.
4 Felson, H., McGuire, J., and Wasserman, P.:
Stromal Endometriosis Involving the Heart,
Am. J. Med, 19: 1072, 1960.
5 Fleishman, S. J., and Davidson, J. F., Vicarious
Menstruation, a Likely Case of Pulmonary
Endometriosis, Lancet 2: 88, 1959
6 Hobbs, J. E., and Bortnick, A. R.: Endometriosis
of Lungs: Experimental and Clinical
Study, Am. J. Obst. & Gynec. 40: 832 1940.
7 Kishkovsky, A. N., and Baskaskov, V. P.:
Roenigen Diagnosis of Pulmonary Endometriosis,
Vesin, Renigen, 38: 44, 1963
8 Lattes, R., Shepard, F., Tovell, H., and Wylie,
R.: Clinical and Pathological Study of Endo-
Metriosis of Lung, Surg., Gynec. & Obst. 103:
552, 1956
9 Maurer, E, R., Schaal, J. A., and Mendez, F.
L.: Chronic Recurring Spontaneous Pneumo-
Thorax Due to Endometriosis of the Diaphragm,
J. A. M. A.. 168: 2013, 1958
10 McSwain, H, T., and Siebel, E. K.: Spontaneous
Pneumothorax Associated with Menstruation
or Endometriosis. Presented at the Annual
Meeting of Southern Thoracic Surgical Association,
11 Mobbs, G. A., and Planner, D. W.: Endometriosis
of the Lung, Lancet 1: 472, 1963
12 Nicholson, H.: Endometriosis of the Pleura, Thorax
6: 75, 1951
13 Ripstein, C. B., Rohman, M., and Wallech
J. B.: Endometriosis Involving the Pleura,
J. THORACIC SURG, 37: 464, 1958
14 Rodman, M. H., and Jones, C. W.: Catamenial
Hemoptysis Due to Bronchial Endometriosis,
New England J. Med. 266: 805,
15 Schwartz, O. H.: Endometriosis of the Lung.
In discussion of “Endometriosis, a Clinical
and Surgical Review” by V. S. Counsellor,
Am. J. Obst. & Gynec. 36: 887, 1938
16 Skobel, P.: Diaphragmatic Complications in
Endometriosis and Miegs Syndrome, Ziachr,
Tuberk, 120: 22, 1963 (German)
17 Sturzennegger, H.: Endometriosis of the Lungs
Simulating Tuberculoma, Schweiz Z, Tuberk.
17: 259, 1960 (German)
18 Williams,J. F., Williams, J. B., and Harper,
J W.: Thoracic Endometriosis, Am. J. Obst.
& Gynec. 84: 1512, 1962.

Dr. Wallace has written a book

Please visit Dr Wallace's website for more information and to order your copy http://www.catamenialpneumothorax.org/

Glynis D. Wallace DMD, former Major in the United States Air Force. Diagnosed and treated at military facilities around the world during her illustrious military career. She is an internationally acclaimed champion and authority on living with this often under diagnosed and misunderstood disease.

Endometriosis has been documented in
almost every body organ.


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