Patients who experience recurrence after treatment with the above management plan are candidates for either a prolonged trial of menstrual suppression with Gn-RH analogues or another attempt at a combined trial of medical and surgical therapy. Thoracotomy should be strongly considered for patients requiring reoperation. If possible, a transaxillary or muscle sparing approach should be performed. The report of Slasky et al. describes resection of all or part of the central tendinous portion of the diaphragm containing the area of fenestrations, at the time of pleurodesis, in three patients with catamenial pneumothorax. If adopted this technique probably should be reserved for patients undergoing open thoracotomy due to the potential for hepatic injury and the need for reconstruction of the diaphragm.
Catamenial pneumothorax is therefore an increasingly recognized concern in young women.
It may be diagnosed with a history of recurring pneumothoraces, notably right-sided, associated with the monthly onset of menses. Associated risk factors include a history of pelvic endometriosis. Tube thoracostomy is used to treat the initial episode if respiration is compromised or if a large pneumothorax is present. Specific treatment with Gn-RH analogues is indicated for recurrence. If further surgery is planned for recurrence after this initial therapy, an open approach through a transaxillary or muscle sparing incision should be performed.