Dear Friends,
An easy case to get ready for summer vacation. Images belong to a 43-year-old woman with recurrent episodes of chest pain. What would be your diagnosis?
Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.
Click here for the answer to case #118
Findings: PA chests in 2010, 2012 (not shown) and 2013 show a right pneumothorax (A-B, arrows) with the typical “V line at the base (A-B, red arrows).
The patient had painful menses and the pneumothoraxes coincided with the menstruation. Abdominal surgery found pelvic endometriosis. MRI of the chest demonstrated an area of high signal intensity in the pleura (C-D, arrows) compatible with pleural endometriosis.
Final diagnosis: catamenial pneumothorax
Congratulations to Genchi Bari who was the first to suggest the diagnosis, followed by Alberto Montemayor five hours later.
Teaching point: recurrent pneumothorax has many etiologies; when occurring on the right side in a fertile woman, endometriosis should be considered as a probable cause.
Reccurent spontaneous pneumothorax due to bullous emphysema.
…la diagnosi è semplice e pronta…..ma come il simpaticissimo professore aspetterò a dirla…..come lui divertendomi….donna…polmone pulito…pntoraci recidivanti…..se lo sai lA riconosci….il tutto parte da molto lontano,,,,la pelvi!!!!è esclusiva delle donne fertili…..
Female patient between the ages of 30 and 50 years with recurrent pneumothoraces we should think in: Pulmonary lymphangioleiomyomatosis.
I AGREE LAM !!!!!
Catamenial pneumothorax
Chronic pneumothorax in a patient with pectus excavatum.
Interstitial intralobular progressive infiltrate with air trapping and neumothorax…
Hydro pneumothorax RT side
Good, I see you all are warming up!
For those of you diagnosing LAM, do you see any lung changes?
Findings which suggest LAM:
Hydrompneumothorax, the fluid ma be from a chylous pleural effusion.
Hyperinflation of both lungs
Some diffuse bilateral reticulonodular densities, more seen in RUL.
+ Recurrent pneumothoraces
Don’t you think it unusual that the pneumothorax is always in the right side?
The second DD is Catamenial Pneumothorax.
but a spontaneous pneumothorax occurring always within 72 hours of menstruation and most of patients has evidence of endometriosis.
Patient had painful menses
The right sided recurrent pneumothorax with painful menses makes Catamenial Pneumothorax is the first diagnosis sir.
Hyperexpanded lungs…Pneumothorax (Image 1 and perhaps 2 if supine), indistinct right cardiac border…I am thinking of Pectus excavatum (with possible Marfan’s)…
Hyperexpanded lungs…recurrent pneumothorax…indistinct cardiac border in favour of pectus excavatum…I am thinking of Marfan’s
…la chiave di lettura è nel 1 radiogramma ove si osserva chiaramente un ispessimento ed irregolarità della pleura viscerale….il polmone sottostante è ” pulito”( non enfisema nè linfagioleeiomiomatosi)…pertanto la diagnosi è di pntoraci recidivanti in rapporto ad endometriosi pleurica…
Right pneumothorax. L AM or catamenial pneumothorax due to pulmonary endometriosis.
Right diagnosis given at the eleventh hour!
Very interesting and useful, as always! 🙂