Abstract / Summary
Catamenial pneumothorax is an uncommon manifestation of thoracic endometriosis syndrome, characterized by recurrent spontaneous pneumothorax occurring in synchronization with the menstrual cycle. It is frequently underdiagnosed due to atypical presentations and insufficient clinical suspicion. This case highlights the importance of early clinical suspicion and the necessity of a multidisciplinary surgical approach. A 34-year-old woman, presented with right upper quadrant pain radiating to the shoulder, initially misdiagnosed as gallbladder disease and managed with laparoscopic cholecystectomy. Despite surgery, her symptoms persisted and progressed to include dyspnea. Imaging later revealed recurrent right-sided hydropneumothorax. She underwent multiple video-assisted thoracoscopic surgeries, which identified pleural adhesions, diaphragmatic fenestrations, and endometriotic lesions. Due to persistent recurrence, the procedure was escalated to open thoracotomy with diaphragmatic repair using mesh and talc pleurodesis. Histopathology and immunohistochemistry confirmed thoracic endometriosis. Postoperatively, the patient achieved complete lung re-expansion and was started on adjunct hormonal therapy, with no recurrence observed during short-term follow-up. Catamenial pneumothorax should be suspected in reproductive-age women with cyclical thoracic or right upper quadrant symptoms. This case highlights the importance of early clinical recognition and a multidisciplinary approach to diagnosis and management.