Cardiothoracic Surgery |

Vanishing Lung Syndrome in a Patient With HIV Infection and Heavy Marijuana Use FREE TO VIEW

Basheer Tashtoush, MD; Fernando Gonzalez-Ibarra, MD; Parag Chevli, MD
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Mount Sinai School of Medicine, Jersey City Medical Center. Department of Internal Medicine, Jersey City, NJ

Chest. 2013;144(4_MeetingAbstracts):106A. doi:10.1378/chest.1701111
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SESSION TITLE: Surgery Student/Resident Case Report Posters

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Vanishing lung syndrome (VLS) is a rare and distinct clinical syndrome that usually affects young men. VLS leads to severe progressive dyspnea and is characterized by extensive, predominantly asymmetric, upper lobe giant lung bullae. Case reports have suggested an additive role of marijuana use in the development of this disease in young male tobacco smokers.

CASE PRESENTATION: We here in report a case of a 65-year-old Hispanic male previously diagnosed with severe emphysema, and acquired immune deficiency syndrome (AIDS), with a history of intravenous heroin use and active marijuana smoking who presents to the emergency department with severe progressive shortness of breath and found to have multiple large subpleural bullae occupying more than one-third of the hemithorax on chest Computerized Tomography (CT), characteristic of vanishing lung syndrome. The patient was mechanically ventilated and later developed pneumothorax requiring chest tube placement and referral for surgical bullectomy.

DISCUSSION: Marijuana smoking leads to an asymmetrical bullous disease, often in the setting of a normal chest X-ray and lung function test. In subjects who smoke marijuana, the pathological changes of emphysema occur at a younger age (approximately 20 years earlier) than in tobacco smokers, also the location of the large pulmonary bullae are found mostly in a paraseptal distribution with a marked predisposition for the upper lobes. HIV infection confers an increased risk for emphysema when compared to control subjects (15% vs 1% respectively). To the best of our knowledge the association between HIV infection and heavy marijuana use as a risk factor for VLS has not been previously described in literature.

CONCLUSIONS: Surgical bullectomy has shown high success rates in alleviating the debilitating symptoms and preventing the life threatening complications of this rare syndrome. This case further emphasizes the importance of recognizing VLS in patients with severe emphysema and heavy marijuana smoking.

Reference #1: Johnson MK, Smith RP, Morrison D, Laszlo G, White RJ. Large lung bullae in marijuana smokers. Thorax 2000; 55:340-342.

Reference #2: Hii SW, Tam JD, Thompson BR, Naughton MT. Bullous lung disease due to marijuana. Respirology. 2008; 13:122-127.

Reference #3: Palla A, Desideri M, Rossi G, Bardi G, Mazzantini D, Mussi A, Giuntini C. Elective surgery for giant bullous emphysema: a 5-year clinical and functional follow-up. Chest. 2005; 128:2043-2050.

DISCLOSURE: The following authors have nothing to disclose: Basheer Tashtoush, Fernando Gonzalez-Ibarra, Parag Chevli

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