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      Catamenial pneumothorax in a 14-year-old female: A case report and literature review

      case-report
      a , , a , b
      Respiratory Medicine Case Reports
      Elsevier

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          Abstract

          Background and aims

          Pneumothoraces can occur in patients of all ages and genders. We encountered a female adolescent patient who was experiencing recurrent pneumothoraces every several months. She endured an extensive workup to determine an etiology for her pneumothoraces but it was all negative. She was eventually diagnosed with catamenial pneumothorax. This is an established cause of recurrent pneumothorax in adults but is very rare in adolescent patients. Keeping it on the differential for any female of reproductive age with recurrent pneumothoraces may prevent potentially harmful and expensive diagnostic testing and procedures.

          Methods

          We reported a case of catamenial pneumothorax in an adolescent patient and reviewed the relevant literature.

          Results

          Our patient was a 14-year-old female patient with recurrent pneumothoraces every several months. She had an extensive procedural and genetic workup performed but no etiology was revealed. Due to a temporal relation of the pneumothoraces to menses, an obstetrics and gynecology consult was obtained. Empirical treatment for catamenial pneumothorax was started with a continuous oral contraceptive with combined estrogen-progestin leading to our patient's complete remission. Three years later our patient has not experienced any relapsing episodes of pneumothorax.

          Conclusion

          Although rare in younger patients, catamenial pneumothorax should be considered as a cause for recurrent pnueumothoraces in any post-pubertal female.

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          Most cited references6

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          Factors related to recurrence of spontaneous pneumothorax.

          The purpose of this retrospective study was to identify factors associated with recurrent spontaneous pneumothorax (SP) in southern China, and to compare the therapeutic effectiveness of different procedures. A total of 182 consecutive patients (89.0% male; mean age, 38.9 years), admitted with their first episode of pneumothorax, were reviewed retrospectively. Follow up was available in 138 patients (75.8%), including 68 treated by chemical pleurodesis and 70 by chest tube drainage alone. The cumulative recurrence rates with different therapeutic procedures and different chemical sclerosing agents were compared, and the factors that influenced the recurrence rate were analysed using Cox's proportional hazard model. The most common pre-existing lung disease responsible for pneumothorax was COPD (69.7%), followed by tuberculosis (16.5%). Recurrence was significantly more common in taller patients, patients with lower weight, and patients with secondary spontaneous pneumothorax. The cumulative recurrence rates in the pleurodesis therapy group after 6 months, 1 and 3 years were 13, 16 and 27%, respectively, whereas in the chest tube drainage group the recurrence rates were 26, 33 and 50%, respectively (P < 0.05). There was no significant difference in the recurrence rate for those receiving tetracycline compared with those who received gentamicin. Spontaneous pneumothorax patients who are taller, weigh less or have secondary spontaneous pneumothorax are more likely to have recurrences. The risk of recurrence is reduced in patients who undergo chemical pleurodesis. Since there was no significant difference between intrapleural tetracycline and gentamicin, gentamicin should be considered as a potential chemical sclerosing agent.
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            Pediatric spontaneous pneumothorax.

            Spontaneous pneumothorax (SP) occurs when air enters the pleural space in the absence of a traumatic or iatrogenic etiology and is an uncommon phenomenon in the pediatric population. Although the typical presentation has been well described in the literature, much debate still surrounds the epidemiology, pathophysiology, diagnosis, and management of this condition in the pediatric population. To date, much of the emphasis in the pediatric literature has been on surgical options. Questions still remain regarding the true incidence of this disease in children, appropriate diagnostic imaging, and treatment recommendations for practitioners in the emergency department setting. This review of the evidence seeks to elaborate on current knowledge and clinical practice, as well as the applicability of adult recommendations to the pediatric population.
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              Catamenial Pneumothorax, a Commonly Misdiagnosed Thoracic Condition: Multicentre Experience and Audit of a Small Case Series With Review of the Literature

              Catamenial pneumothorax (CP) is an unusual condition affecting premenopausal women and commonly misdiagnosed as simple pneumothorax. It is characterised by its recurrence between the day before and within 72 hours after the onset of menstruation. It has been associated with thoracic endometriosis but the aetiology is not well understood and there is no unified agreement for its optimal management. The aim of this study is to determine the incidence of CP in surgical patients and the results of their treatment.
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                Author and article information

                Contributors
                Journal
                Respir Med Case Rep
                Respir Med Case Rep
                Respiratory Medicine Case Reports
                Elsevier
                2213-0071
                14 October 2019
                2019
                14 October 2019
                : 28
                : 100951
                Affiliations
                [a ]MedStar Georgetown University Hospital, Department of Pediatrics, USA
                [b ]MedStar Georgetown University Hospital, Division of Pediatric Pulmonary and Sleep Medicine, USA
                Author notes
                []Corresponding author. Department of Pediatrics, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, 20007, USA. andrew.w.kramer@ 123456gunet.georgetown.edu
                Article
                S2213-0071(19)30261-8 100951
                10.1016/j.rmcr.2019.100951
                6831874
                debe4f83-0006-4913-bd1c-cf2f33b6808a
                © 2019 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 22 August 2019
                : 23 September 2019
                : 12 October 2019
                Categories
                Case Report

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