Abstract Spontaneous pneumothorax occurs due to disruption of the visceral or parietal pleura, allowing air to enter the pleural cavity from the atmosphere or airways. It is classified as primary, in the absence of underlying pulmonary disease, or secondary, when associated with pre-existing lung pathology. The incidence is approximately 14.1 cases per 100,000 individuals annually (aged 15 years), commonly presenting with acute chest pain or dyspnea, often as a medical emergency. Etiologies are multifactorial, including smoking, low body mass index, subpleural blebs or bullae, connective tissue disorders, cystic lung disease, catamenial causes, and familial predisposition (≈10%). Diagnostic evaluation involves chest radiography, with computed tomography for recurrent or complex cases and magnetic resonance imaging for suspected catamenial pneumothorax. Management includes needle aspiration or chest drainage, with definitive treatment through VATS and pleurodesis ± bullectomy to prevent recurrence. CASE A 22-year-old female with no significant comorbidities presented with a two-day history of dyspnea and chest tightness. Imaging at an outside hospital revealed a large right pneumothorax with partial lung collapse, successfully managed with pigtail catheter insertion, achieving resolution over three days. Notably, symptom onset coincided with menstruation, and there was a strong familial history of spontaneous pneumothorax involving her brother, uncle, and grandmother, with her uncle requiring pleurodesis. Four days post-discharge, she re-presented with recurrent right-sided chest pain and dyspnea. Chest radiography confirmed recurrence, and a right pigtail catheter was reinserted, resulting in symptomatic improvement. Non-contrast CT chest revealed a 5.6 cm bulla at the right lower lobe base. She underwent VATS with right lower lobe bullectomy, total parietal pleurectomy, and mechanical pleurodesis. No diaphragmatic defects were observed intraoperatively. Histopathology showed benign pleura with mesothelial hyperplasia and no inflammation, malignancy, or endometriosis. Recovery was uneventful with full lung re-expansion. Conclusion 1. Multifactorial Etiology: This case demonstrates the potential interplay between familial predisposition and catamenial factors in the pathogenesis of spontaneous pneumothorax in young females, emphasizing the need to evaluate both hereditary and hormonal influences. 2. Diagnostic and Therapeutic Approach: Comprehensive imaging to detect bullous lung changes and timely surgical management with VATS, pleurectomy, and pleurodesis are essential to achieve complete resolution and prevent recurrence. 3. Histopathological Correlation: The absence of diaphragmatic defects or endometriosis, despite catamenial timing, indicates that temporal association alone is not diagnostic, reinforcing the importance of multidisciplinary and individualized management strategies. This abstract is funded by: None
Azhar et al. (Fri,) studied this question.