Comment to the article: Diaphragmatic patch: a useful adjunct in surgical treatment of recurrent catamenial hemothorax.

The present work reviews the catamenial hemothorax and its relation to two potential clinical cases. Hemothorax is a condition usually associated to thoracic trauma, iatrogenesis, pneumothorax, and malignant or infectious pleural disease. Apart from these clinical entities, the presence of hemothorax is not frequent and its etiology is usually difficult to ascertain. Thoracic endometriosis is one of the rare entities that can be responsible for the presentation of a hemothorax, and the diagnosis is relatively easy when endometriosis foci are found within the thoracic cavity. More frequently, hemothorax is clinically diagnosed in female patients with abdominal endometriosis presenting pneumothorax and/or hemothorax associated with the end phase of the menstrual cycle. Other cases are usually labelled as idiopathic cases. Regarding the treatment, the use of drainage alone can be sufficient; as a matter of fact, autologous blood was injected in the pleural space as the treatment for pneumothorax since it facilitates the development of pleural adherences. Cleaning of pleural cavity through videothoracoscopy, combined with pleural and diaphragmatic abrasion, could facilitate the diagnosis and, at the same time, solve the problem. In case of relapse, total or partial parietal pleurectomy could be a more aggressive option for the management of this entity. In every case, pleural examination and lung palpation should be done in order to identify the presence of lung bullas, endometriosis foci or nodules that should be resected for diagnosis and treatment purposes. The diaphragm should be carefully inspected for the identification and closure with suture of orifices that can be occasionally found. Talc produces intense adherences in the pleura, and its use is recommended for the treatment of malignant pleural effusions as palliative treatment. However, talc poudrage