Question:

Which of the following imaging modalities are used to assess catamenial pneumothorax?
1. Plain chest radiography.
2. Computed Tomography (CT) w/ and w/o contrast.
3. Magnetic Resonance Imaging (MRI) w/ and w/o contrast.
4. Video-assisted thoracoscopy (VATS).
5. Nuclear Imaging.





Answer:

The correct answers for the question "Which of the following imaging modalities are used to assess catamenial pneumothorax?" are:

1. Plain chest radiography.

2. Computed Tomography (CT) w/ and w/o contrast.

4. Video-assisted thoracoscopy (VATS).



Explanation
1. Plain chest radiography can be used to initially assess the presence of pneumothorax, however is not as sensitive as CT to pick up pleural nodularity. [Pneumothoraces can be seen on plain x-ray or CT. CT imaging is more sensitive and more readily portrayed small pleural and omental nodules in this patient that were later confirmed to be endometrial implants via biopsy.]

2. CT can pick up pneumothoraces, as well as pleural nodularity with associated omental nodularity suggestive of catamenial pneumothorax. [Pneumothoraces can be seen on plain x-ray or CT. CT imaging is more sensitive and more readily portrayed small pleural and omental nodules in this patient that were later confirmed to be endometrial implants via biopsy.]

3. Though MRI imaging could also show pneumothoraces and pleural nodularity, it is usually does not provide addition information beyond a CT. [MRI imaging is usually unnecessary and does not provide any addition information not seen CT.]

4. Video-assisted thoracoscopy portrays characteristic red-brown lesions on the pleural surfaces that helps diagnose pleural endometriosis which is then confirmed via biopsy. [Biopsy was conducted via thoracoscopy. Most patients undergo video assisted thoracoscopy which show small red brown nodular lesions characteristic of endometrial implants.]

5. Nuclear imaging is not used to assess catamenial pneumothorax, however is often used to confirm diagnosis of thoracic splenosis via technetium 99m tagged RBCs. [The true diagnosis for thoracic splenosis  is usually made via nuclear imaging, specifically when technetium 99m tagged RBCs can acculmate in the autotransplanted spleen.]



From the manuscript:
A Case of Multisystem Endometriosis
Radiology Case. 2013 Oct; 7(10):1-6


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From the manuscript

A Case of Multisystem Endometriosis

Free full text article: A Case of Multisystem Endometriosis

Abstract
Catamenial pneumothorax is a rare complication secondary to pleural endometriosis. We present a case of a 37-year-old-female with a history of recurrent pneumothoraces with an associated temporal relationship to the onset of her menses. In addition to her recurrent pneumothoraces, on further evaluation, she was found to have multiple nodular masses within the omentum. A thoracoscopic biopsy was subsequently performed, which showed endometrial implants within the pleural space and within the omental cavity. The radiological features and pathogenesis of this rare disease are reviewed and discussed with reference to relevant literature.






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