[Catamenial pneumothorax. Failure of videothorascopic treatment].

INTRODUCTION: Catamenial pneumothorax occurs in women during the menses. It is frequently associated with diaphragmatic fenestrations or episodes of pleural endometriosis. OBSERVATION: We report the case of a patients who had presented 25 episodes of right pneumothorax despite treatment with videothorascopy initiated after the 10th episode. These episodes coincided with menstruation. Diagnosis of catamenial pneumothorax was evoked and thoracic surgery was indicated. Exploration of the pleural fossa did not reveal symphysis but 7 diaphragmatic orifices, which were sutured before conducting mechanical pleurodesis. No relapse of pneumothorax was reported following surgery. COMMENTS: Around one hundred cases of catamenial pneumothorax have been reported in the literature. They represent 2.8 to 5.6% of spontaneous pneumothroax in women. Diagnosis is evoked on the occurrence of recurrent pneumothorax appearing 24 to 72 hours after the onset of menstruation. The pathogeny is uncertain and several mechanisms are frequently evoked. In the prevention of relapses, treatment consists in closing the diaphragmatic orifices with thoracotomy, resection of eventual bubbles, and pleural symphysis. Videothorascopy does not appear adapted to treatment.