A Case of Thoracic Endometriosis Syndrome Presenting with Recurrent Catamenial Pneumothorax.

BACKGROUND Catamenial pneumothorax (CP) is a spontaneous pneumothorax commonly associated with menstrual periods. Endometrial tissues most commonly involve the pelvic region. However, after the pelvis, the lungs are most frequently involved. Thoracic endometriosis should always be suspected in young women presenting with CP. CASE REPORT A 30-year-old woman with history of endometriosis presented with chief complaint of umbilical pain. A computerized tomography (CT) scan of the abdomen and pelvis was performed, which showed an incidental finding of a large right-sided pneumothorax. Chest X-ray imaging showed 50% pneumothorax. A right-sided chest tube was placed, and after the procedure, a chest X-ray image showed expansion of the right lung. The patient was readmitted for elective resection of an umbilical mass and was again incidentally found to have a recurrent pneumothorax on the right side. She underwent videothoracoscopic pleurodesis with pathology, establishing the diagnosis of catamenial pneumothorax. CONCLUSIONS Thoracic endometriosis resulting in catamenial pneumothorax should be suspected in young women of child-bearing age. Treatment options still under debate include endoscopic resection and videothoracoscopic pleurodesis followed by gonadotrophin-releasing hormone (GnRH) therapy to reduce the rate of postoperative recurrence.

A Case Report of Cystic Pheochromocytoma.

BACKGROUND Pheochromocytoma is a rare catecholamine-producing tumor with an estimated incidence of less than 0.1% in the global population. We present a case of cystic pheochromocytoma that was diagnosed as an incidental finding. The patient presented with abdominal pain and had a history of hypertension. CASE REPORT A 64-year-old man with hypertension presented with a clinical history of intermittent abdominal pain for one year. He denied sweating, palpitations, headache or back pain. He was found to have an elevated blood pressure of 170/90 and no palpable abdominal mass. Contrast-enhanced computed tomography (CT) imaging of the abdomen and pelvis were performed that showed cystic mass measuring 9 cm in diameter arising from the left adrenal gland with contrast-enhancing mural nodules. Magnetic resonance imaging (MRI) confirmed the cystic nature of the mass. Laboratory analysis showed an elevated plasma normetanephrine (NMN) of 1,087 pg/ml and metanephrine (MN) of 372 pg/ml; 24-hour urine showed elevated levels of NMN and MN, 3,002 mg/24 h and 1,596 mg/24 h, respectively. Given the laboratory and radiologic findings, a diagnosis of cystic pheochromocytoma was made. After controlling blood pressure with the alpha-blocker, doxazosin, the patient was hydrated and scheduled for an elective adrenalectomy. The histopathology of the excised adrenal gland was consistent with a cystic pheochromocytoma. CONCLUSIONS Cystic pheochromocytoma is a very rare tumor that may present without symptoms. The clinical course of cystic pheochromocytoma is similar to that of solid pheochromocytoma. Early surgical intervention is recommended, following blood pressure control with an alpha-blocker, and adequate hydration.