Recurrent Pneumothoraces in a 36-Year-Old Gravid Woman

Recurrent pneumothoraces in a 36-year-old pregnant woman were investigated. The patient had a history of multiple episodes of pneumothorax and imaging showed cystic lung changes and pulmonary nodules. Common causes of cystic lung disease in women of reproductive age were considered, including lymphangioleiomyomatosis (LAM), pulmonary Langerhans cell histiocytosis, Birt-Hogg-Dub syndrome, and lymphocytic interstitial pneumonia. The patient underwent an extensive workup ruling out most of these causes. The diagnostic approach was then broadened to rare or metastatic causes of cystic lung disease. Thoracic endometriosis (TE) was considered due to the patient's worsening symptoms during pregnancy. TE is a rare cause of cystic lung disease and has been associated with spontaneous pneumothorax. Hormonal therapy and surgical interventions were discussed as treatment options. The patient was started on leuprorelin acetate depot injection and has not experienced another pneumothorax. Definitive treatment with hysterectomy and bilateral salpingooophorectomy is being considered. Thoracic endometriosis should be included in the differential diagnosis of estrogen-mediated spontaneous pneumothorax in young women.