Flow chart of the diagnosis and treatment of a case of catamenial pneumothorax]

A 44-year-old female had sudden cough during menstruation. She visited a clinic and mild right pneumothorax was pointed out on chest X-ray. She was admitted to our hospital for continuous pneumothorax and tube drainage was performed. Although pneumothorax improved within a week after drainage, catamenial pneumothorax was suspected because her serum CA 125 showed a high value of 109 U/ml. Therefore diagnostic pneumoperitoneum was performed during the next menstruation, and right pneumothorax occurred. Laparoscopy revealed pelvic endometriosis and thoracoscopy revealed a few small holes in the right diaphragm. The case was diagnosed as catamenial pneumothorax and hormonal treatment was given. She had been well for one year without recurrence of pneumothorax. The authors made a flow chart for diagnosis and treatment based on this case and discussed its value in relation to cases described in the literature.