Catamenial pneumothorax is a spontaneous pneumothorax that occurs predominantly women of child bearing age. We describe a case of a 40-year-old nulliparous woman with medical history significant for endometriosis who presented with severe chest tightness of one-day duration. Chest radiography (CXR) showed a large right spontaneous pneumothorax, what was thought to be a 5.6 cm pleural mass at the right lung base. Following pneumothorax diagnosis, the patient underwent emergent right thoracostomy with pigtail catheter placement. A repeat CXR revealed marked re-expansion of the lung but persistence of a right pleural mass. Follow up computed tomography scan of the chest showed a 33 mm diaphragmatic defect with 5.8 x 4.6 x 3.9 cm area of herniated liver corresponding to the presumed pleural mass. Following complete thoracic imaging, patient underwent video-assisted thoracoscopic surgery, mechanical pleurodesis, and open repair of the right diaphragmatic defect. Intraoperatively, an endometrial implant was noted on the chest wall. On postoperative day three, she began her menstrual cycle and was evaluated by gynecologist who recommended hormonal therapy to reduce risk of recurrent pneumothorax. Due to a persistent air leak, the chest tube was transitioned to a Heimlich valve to facilitate home discharge. The patient was discharged on postoperative day eight, seen as outpatient with resolution of air leak and removal of chest tube.
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机译：加泰罗尼亚气胸是一种自发性气胸，主要发生在育龄妇女中。我们描述了一个40岁的未产妇的病例，该病的病史对子宫内膜异位症具有重要意义，并表现为持续一天的严重胸闷。胸部X线摄片（CXR）显示右大自发性气胸，被认为是右肺底部的5.6 cm胸膜肿块。诊断为气胸后，该患者接受了紧急的右胸肋切开术，并放置了猪尾导管。重复进行的CXR显示肺明显扩张，但右胸膜肿块持续存在。胸部的后续计算机体层摄影术扫描显示33 mm diaphragm肌缺损，其中5.8 x 4.6 x 3.9 cm的突出肝脏面积对应于假定的胸膜肿块。在完成胸部影像学检查后，患者接受了电视胸腔镜手术，机械性胸膜固定术和右diaphragm肌缺损的开放性修复。术中在胸壁发现子宫内膜植入物。术后第三天，她开始了月经周期，并由妇科医生进行了评估，妇科医生建议进行激素治疗以减少复发性气胸的风险。由于持续的漏气，胸管过渡到Heimlich瓣膜以利于家庭出院。该患者在术后第8天出院，被视为门诊患者，已经解决了漏气和移除胸管的问题。
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