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Vol. 17. Issue 6.
Pages 278-280 (November - December 2011)
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Vol. 17. Issue 6.
Pages 278-280 (November - December 2011)
Case report
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Diaphragmatic patch: A useful adjunct in surgical treatment of recurrent catamenial hemothorax
Penso diafragmático: um auxiliar útil para o tratamento cirúrgico de hemotórax recorrente catamenial
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J. Nwiloh
Section of Cardiothoracic Surgery, Atlanta Medical Center, Atlanta, GA, United States
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Abstract

Although catamenial hemothorax compared to pneumothorax is a rarer clinical pre-sentation of thoracic endometriosis syndrome (TES), it is more commonly associated with diaphragmatic fenestrations. These openings may serve as entry portals for peritoneal fluid to access into the pleural space thereby perpetuating recurrent pleural effusion even after prior surgical pleurodesis. We report our experience with two patients with recurrent right catamenial hemothorax after previous interventions that were subsequently treated by talc pleurodesis and goretex diaphragmatic patch, and who have had no further recurrence at a mean follow up of 15 months. We therefore recommend that diaphragmatic patch should be considered as an adjunct to talc pleurodesis in patients with recurrent catamenial hemothorax when either multiple diaphrag-matic fenestrations are seen at surgery or if there is concomitant bloody peritoneal fluid which could potentially lead to recurrence. The patch by sealing any occult pores and possible future fenestrations appear to decrease recurrent pleural effusion at an intermediate term follow up.

Keywords:
Catamenial hemothorax
Diaphragmatic pores
Resumo

Embora o hemotórax catamenial comparado com o pneumotórax seja uma apresentação clínica mais rara de síndrome de endometriose torácica (TES), está mais asso-ciado a fenestrações diafragmáticas. Estas aberturas podem atuar como portais de entrada para o acesso ao fluido peritoneal na cavidade pleural, perpetuando assim o derrame pleural recorrente mesmo após uma pleurodese cirúrgica prévia. Registamos a nossa experiência em dois pacientes com hemotórax catamenial recorrente do lado direito após outras intervenções, que foram posteriormente tratados com pleurodese com talco e penso diafragmático em gore-tex, e que não apresentaram nenhuma outra recorrência durante um acompanhamento de 15 meses. Recomendamos, então, que o penso diafragmático seja considerado um auxiliar à pleurodese com talco em pacientes com hemotórax catamenial recorrente, tanto quando são vistas várias fenestrações diafragmáticas na cirurgia, como quando há fluido peritoneal hemorrágico concomitante, que poderá conduzir a uma recorrência. O penso, ao selar qualquer poro oculto e possíveis fenestrações futuras, parece diminuir o derrame pleural recorrente num seguimento a médio prazo.

Palavras chave:
Hemotórax catamenial
Poros diafragmáticos
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