Catamenial Pneumothorax: A Unique Case with Multiple Sites of Endometriosis and a Villar’s Nodule

Abstract

Introduction: Endometriosis is the presence of endometrial tissue, glands, and stroma outside the uterine cavity. It affects 10 to 15% of women and it is estrogen-dependent, thus remains closely associated with the perimenstrual period, i.e., 72 hours before or after the menstrual cycle. Various hypotheses were postulated, but the etiology and pathogenesis remain obscure and difficult to explain. However, retrograde outflow of menstrual blood with the open fallopian tube is the most popular explanation. The thoracic Endometriosis is a rare entity, but catamenial pneumothorax has the maximum share in incidence of >72% and is one of the alarming respiratory emergencies. The present case is unique with Endometriosis involving multiple sites.
Case Report: A 30-year-old fertile, lean, thin (Low BMI) woman presented with a history of sudden onset of shortness of breathing with dark umbilical nodule and rectal bleeding during the menstrual cycle. The catamenial pneumothorax was managed with conservative treatment, and the hormonal therapy was initiated with favourable results. The rectal bleeding was managed with a stool softener. USG whole abdomen and Doppler study of the umbilical region depicted and confirmed the diagnosis of umbilical Endometriosis (Villar’s Nodule) with minimal ascites.
Conclusion: Endometriosis is a chronic, benign disease that affects women throughout the world. In most occasions, it remained confined to the Pelvis with vague symptoms including backache. A detailed menstrual history should be taken and is an integral part of all medical examinations. This case becomes unique and worth presenting with umbilical Endometriosis, rectal bleed, hemorrhagic ovarian cyst, together with catamenial pneumothorax as a rare emergency of Respiratory Medicine.