Friday, April 11, 2008

Timing is Everything

A 35 year old woman presents with pleuritic chest pain and dyspnea. Her X-ray is shown above; the diagnosis is easy. But as you are about to discharge her, you see something interesting in her medical chart. She has presented with the same diagnosis every month for the last six months. Though the idea of Munchausen's or factitious disorder crosses your mind, you realize that the diagnosis was confirmed every time. She also denies self-inflicting this. As you focus on the past medical history, you realize she's gotten this problem every 28 days.

Challenge: What's the diagnosis?

Image shown under fair use.

*Note: I'm on vacation Monday, so the next case will be next Wednesday.

1 comment:

Craig said...

Timing is Everything

This is the presentation of catamenial pneumothorax, recurrent pneumothoraces that occur within 24-48 hours of onset of menstruation. The cause is thoracic endometriosis, presence of endometrial glands and tissue outside the uterine stroma and musculature. Treatment can be hormonal (OCPs, progestins, danazol, or GnRH analogs) or surgical.

Sources: UpToDate,