CA-125 is elevated. Clinical diagnosis can be made based on history and imaging, while the gold standard for definitive diagnosis remains Video-assisted thoracoscopic surgery, or VATS, which allows not only the visualization of the lesion, but also surgical treatment via cauterization of the ectopic endometrial tissue. Special staining under a microscope or utilizing a cell marker, such as PAX8, can be used to positively identify endometrial stroma. Classification
Catamenial pneumothorax is the most common form of thoracic endometriosis syndrome, which also includes
catamenial hemothorax, catamenial hemoptysis, catamenial hemothorax and endometriosis lung nodules, as well as some exceptional presentations. Treatment
Pneumothorax can be a medical emergency, as it can become associated with decreased lung function, and if progressed to tension pneumothorax, potentially fatal. In many cases, catamenial pneumothorax will resolve spontaneously and not require immediate intervention. In more severe cases, a chest tube may be required to release air and/or blood and to allow the lung to re-expand.Surgery, hormonal treatments and combined approaches have all been proposed, with variable results in terms of short and long term outcome. These have both been effective, separately and together. Both have been used to treat women with this condition, and specifics depend on each patient and each situation. Surgery may be used to excise endometrial tissue from the lungs and pleural space as well as repair damage and holes in the diaphragm. Surgery may also be used to remove blisters (blebs).
Mechanisms include retrograde menstruation resulting in abdomino-pelvic spread, blood-borne or lymphatic spread and deposition, and metaplasia.Thoracic endometriosis is the most common non-abdominal site of involvement and is also the primary risk factor for catamenial pneumothorax. Catamenial pneumothorax is the primary clinical presentation of thoracic endometriosis, and is defined as recurrent episodes of lung collapse within 72 hours before or after menstruation. Signs and symptoms
Symptoms include chest or shoulder pain, cough, dyspnea, and shortness of breath. Chest and shoulder pain can be radiating out to the shoulder blades. A dry cough can also present and come with a "crackling" sound upon inhaling. Typically, it occurs in women aged 30 to 40 years, but it has been diagnosed in young girls as early as 10 years of age and post menopausal women (exclusively in women of menstrual age), most with a history of pelvic endometriosis.Chest pain requires immediate medical attention. Pathophysiology
Although the exact cause is not known, a few theories come from metastatic, hormonal, and anatomical possibilities. The metastatic model proposes that endometrial tissue has migrated from the endometrium to the diaphragm or the pleural space, causing small holes in the diaphragm, allowing air into the pleural space. In the hormonal model, it is believed that prostaglandin F2 causes a narrowing of the bronchioles, the small tubes within the lungs. Narrowing of these can cause the alveoli to rupture which may trap air in the pleural space.