·She used to feel chest pain and heaviness only during her menses
·Prompt diagnosis and appropriate treatment is necessary to prevent casualty
Sonipat: In treating one of the rare conditions, doctors at BLK-Max Hospital New Delhi performed minimally invasive VATS surgery to provide new lease of life to a 32-year-old teacher from Sonipat. She was diagnosed with a rare condition in which the lungs had repeatedly collapsed during her menses.
The patient used to feel severe chest pain every month during the onset of her menstruation cycle that would aggravate into shortness of breath leading to panic attacks. Since, this continued every month, leaving her in debilitating pain and gasping for air, she used to get admitted every time in a local hospital in Sonipat as her condition gradually worsened.
With examination, doctors in Sonipat performed Inter Costal Chest Drainage (ICD) to provide her some temporary relief. Though detailed multi-disciplinary evaluations were done but the doctors were unable to conclude a prompt diagnosis. In fact patient went to number of doctors including gynaecologists, physicians as well as pulmonologist but no one related chest problem with her menstrual cycle and told her that it could be incidental occurrence. She was even advised oxygen administration at home. While this condition triggered back again, earlier this month, and she had to be admitted, her husband took all the reports to Dr Sandeep Nayar at BLK-Max Hospital for an expert opinion.
Understanding the symptoms, Dr. Nayar told her husband immediately that she could be a case of one of the rarest ailments known as Catamenial Pneumothorax and this would require a specialised management. Her husband was pleasantly surprised to get a diagnosis in no time and decided to shift the patient immediately to BLK Max Hospital through Ambulance and get her thoroughly diagnosed.
“Blood investigations were completely normal, but CT scan of the thorax region showed large right sided pneumothorax with mild pleural effusion and irregular pleural thickening. The team decided to take an opinion from the CTVS team as well before proceeding with the Video Assisted Thoracic Surgery (VATS). After the clearance, she successfully underwent VATS under General Anaesthesia with intubation. Post surgically she was stable and her vitals were normal, and she was extubated the next day.” Said Dr. Sandeep Nayar- Senior Director & HOD- Centre for Chest & Respiratory Diseases, BLK Max Super Speciality Hospital, New Delhi
Catamenial Pneumothorax is an extremely rare condition that affects women, where the air or gas gets trapped in the space surrounding the lungs causing the lungs to collapse. Though the causes are sporadic and the reason is still unknown, some cases can be associated with the abnormal development of the endometrial tissue outside of the uterus. Women ailing from this condition often experience the symptoms within 72 hours before or after the onset of menses.
“Since the symptoms of Catamenial Pneumothorax, may mimic with other conditions or ailments, prompt diagnosis and providing the appropriate treatment on time is necessary to prevent any casualties. If you are not aware of this pathology, you would fail to relate occurrence of lungs problem with the onset of menstruation, and this condition being rare, requires high expertise. This condition may show up later in life even years after the initial treatment and the recurrence rate in patients undergoing surgery may range from 8% to 40%. Thus, finding and resecting the visible pleural lesions are of key importance during the surgical procedure.” Added Dr Nayar. It is a team work to manage such cases and I would like to thank my team comprising Dr. Sunny Kalra, Dr. Manish Garg, Surgeons Dr. Pramod Jindal, Dr. Samad and team, Gynaecologist Dr. Dinesh Kansal and team.
In some cases, post surgically, diaphragm reconstruction must be done in those where diaphragm perforation is noticed, and some may also require hormonal therapy to effectively sustain the effects of the surgical treatment.