Thoracoscopic findings and surgical management of catamenial hemopneumothorax

A 43-year-old woman had experienced recurrent right pneumothoraces at the beginning of her menstrual period. Thoracoscopically, multiple small fenestrations were widely found over the tendinous part of the diaphragm. Multiple purple colored nodules were seen on the visceral surface of upper lobe containing intralobar lesions, and about 100 ml blood was pooled in the thoracic space. We performed a video-assisted thoracoscopic resection of the pleural nodule suspected to be the cause of the hemothoraces. Histologically, the resected nodule had intra-alveolar hemorrhage not seen in common endometriosis. Pleurodesis with mechanical abrasion of parietal pleura and the diaphragm was performed. Chemical pleurodesis, with minocycline hydrochloride and distilled water was applied.