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A 14 Year Old Female Adolescent with Recurrent Pneumothoraces
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A5635 - A 14 Year Old Female Adolescent with Recurrent Pneumothoraces
Author Block: A. Kramer1, M. C. Bautista2; 1Department of Pediatrics Division of Pulmonary and Sleep Medicine, Medstar Georgetown University Hospital, Washington, DC, United States, 2Georgetown Univ Hosp, Washington, DC, United States.
Introduction: Primary spontaneous pneumothorax is approximately 3-6 times more common in males than females. We present a 14 year old healthy female who developed recurrent episodes of spontaneous pneumothoraces.
Case presentation: A 14-year-old previously healthy female presented to the ER with acute history of worsening right-sided chest pain with shortness of breath. She described the pain as dull, diffuse and non-radiating. There were no associated symptoms of cough, fever or dizziness. Physical exam revealed a tall female with lean body habitus. Vital signs were within normal and she was in no acute respiratory distress. Chest exam showed mild scoliosis, no retractions with diminished breath sounds in right lung fields. The rest of the exam was unremarkable. Chest x-ray demonstrated a moderate right pneumothorax which resolved with thoracostomy tube. This was the first of many hospitalizations for this patient who developed nine pneumothoraces (two right and seven left sided) in a two-year period. Five pneumothoraces occurred during her menstrual period and four occurred after her menstrual period. Chest CT done after the first pneumothorax showed no pleural nor pulmonary nodules. Further work up for possible underlying lung disease was negative. She subsequently underwent bilateral VATS, mechanical pleurodesis, pleurectomy and blebectomy, but continued to have recurrence of pneumothoraces. There was no evidence of thoracic endometrial implants seen on VATS. Due to the catamenial nature of most of the episodes of her pneumothoraces, she was referred to Gynecology for management of thoracic endometriosis syndrome. She was empirically started on hormonal therapy and since initiation there has been no recurrence of pneumothoraces in her three years of follow up.
Discussion: Catamemial Pneumothorax (CP), an entity of thoracic endometriosis syndrome mostly occurs in reproductive aged women between 30-40 years old. However, occurrence in female teenagers is very uncommon. Despite this association between pneumothorax and menstruation, literature lacks unified explanation for the exact mechanism of this rare clinical condition. In general, CP in adult women is unilateral and right sided, in contrast to our patient who had bilateral involvement which suggests that the mechanism of CP in adolescent girls is different from adult women. Diagnosis of thoracic endometriosis is by histopathology, but can be made clinically. CP should be considered in teenage girls who present with pneumothorax. Early recognition and treatment may help prevent recurrent pneumothoraces, hospitalizations and morbidity.
Author Block: A. Kramer1, M. C. Bautista2; 1Department of Pediatrics Division of Pulmonary and Sleep Medicine, Medstar Georgetown University Hospital, Washington, DC, United States, 2Georgetown Univ Hosp, Washington, DC, United States.
Introduction: Primary spontaneous pneumothorax is approximately 3-6 times more common in males than females. We present a 14 year old healthy female who developed recurrent episodes of spontaneous pneumothoraces.
Case presentation: A 14-year-old previously healthy female presented to the ER with acute history of worsening right-sided chest pain with shortness of breath. She described the pain as dull, diffuse and non-radiating. There were no associated symptoms of cough, fever or dizziness. Physical exam revealed a tall female with lean body habitus. Vital signs were within normal and she was in no acute respiratory distress. Chest exam showed mild scoliosis, no retractions with diminished breath sounds in right lung fields. The rest of the exam was unremarkable. Chest x-ray demonstrated a moderate right pneumothorax which resolved with thoracostomy tube. This was the first of many hospitalizations for this patient who developed nine pneumothoraces (two right and seven left sided) in a two-year period. Five pneumothoraces occurred during her menstrual period and four occurred after her menstrual period. Chest CT done after the first pneumothorax showed no pleural nor pulmonary nodules. Further work up for possible underlying lung disease was negative. She subsequently underwent bilateral VATS, mechanical pleurodesis, pleurectomy and blebectomy, but continued to have recurrence of pneumothoraces. There was no evidence of thoracic endometrial implants seen on VATS. Due to the catamenial nature of most of the episodes of her pneumothoraces, she was referred to Gynecology for management of thoracic endometriosis syndrome. She was empirically started on hormonal therapy and since initiation there has been no recurrence of pneumothoraces in her three years of follow up.
Discussion: Catamemial Pneumothorax (CP), an entity of thoracic endometriosis syndrome mostly occurs in reproductive aged women between 30-40 years old. However, occurrence in female teenagers is very uncommon. Despite this association between pneumothorax and menstruation, literature lacks unified explanation for the exact mechanism of this rare clinical condition. In general, CP in adult women is unilateral and right sided, in contrast to our patient who had bilateral involvement which suggests that the mechanism of CP in adolescent girls is different from adult women. Diagnosis of thoracic endometriosis is by histopathology, but can be made clinically. CP should be considered in teenage girls who present with pneumothorax. Early recognition and treatment may help prevent recurrent pneumothoraces, hospitalizations and morbidity.
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