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Bullous Emphysema in a Patient With Chronic Cocaine Inhalation FREE TO VIEW

Ankush Asija, MD; Abha Patel, DO; Aasim Mohammed, MD; Andy Goberdhan, MD; Shriyanka Jain, MD; Dhruvan Patel, MD; Fatima Babar, MD
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Mercy Catholic Medical Center, Aldan, PA

Chest. 2015;148(4_MeetingAbstracts):516A. doi:10.1378/chest.2263952
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SESSION TITLE: Imaging Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: We report a case of a young female with multiple large upper lobe bullae with a long standing history of Cocaine smoking. Based on her initial presentation, alpha-1 antitrypsin deficiency was considered but later rejected given the patient's high alpha-1 antitrypsin levels. In light of her clinical picture, Cocaine abuse must be considered in the differential of premature bullous emphysema.

CASE PRESENTATION: A 39 year old African American female presented to our institution initially with complaints of menorrhagia. She had no respiratory symptoms. However, on exam she had decreased breath sounds bilaterally and dullness to percussion at her lung bases. She was found to have an elevated beta HCG. Her chest X-ray showed bilateral pulmonary masses, a small right pleural effusion, and extensive bilateral upper lobe emphysema. A CT scan was performed which showed bilateral lower lung masses suggestive of choriocarcinoma and multiple large bullae in both of her upper lung lobes. An alpha-1 antitrypsin level was checked and found to be elevated. Her social history was significant for cocaine inhalation every other day and smoking 2-4 cigarettes/day during last 10 years.

DISCUSSION: Giant bullae is a complication of emphysema, with cigarette smoking as the most commonly recognized cause. Congenital deficiency of alpha-1 antitryspin is the most common factor of development of premature pulmonary emphysema. Our case is of particular interest, as the patient's smoking history is relatively limited and her alpha-1 antitrypsin levels were elevated. To the best of our knowledge, long term cocaine abuse has been associated with bullous emphysema in only a few case reports. However, the distribution of lung involvement seen in drug abuse is usually upper lobes in contrast to cigarette smoking which diffusely effects the lungs. In keeping with this, our patient had predominantly upper lobe emphysematous changes consistent with the pattern seen in drug abuse.

CONCLUSIONS: After ruling out other common causes of bullous emphysema, it is reasonable to consider Cocaine as a possible cause of premature bullous emphysema.

Reference #1: JM van der Klooster and A Grootendorst. Severe bullous emphysema associated with cocaine smoking

Reference #2: Ceres Alabau F, Marchán Carranza E, Mañas García MD, Porras Leal L. [Lung emphysema as a rare complication of inhaled cocaine addiction]. [Article in Spanish]

Reference #3: Figueiredo S1, Fernandes G, Morais A. [Bullous emphysema associated with drug abuse].

DISCLOSURE: The following authors have nothing to disclose: Ankush Asija, Abha Patel, Aasim Mohammed, Andy Goberdhan, Shriyanka Jain, Dhruvan Patel, Fatima Babar

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