Lung Pathology: Fellow Case Report Poster - Lung Pathology |

Marijuana Abuse, Vanishing Lung Syndrome, and ARDS FREE TO VIEW

Faraz Siddiqui, MBBS; Tahir Khan, MBBS; Abul Hassan Siddiqui, MBBS; Shimshon Weisel, MD
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Staten Island University Hospital, Staten Island, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):783A. doi:10.1016/j.chest.2016.08.879
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SESSION TITLE: Fellow Case Report Poster - Lung Pathology

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: We present a unique case of vanishing lung syndrome (VLS) complicated by pneumonia and ARDS. We believe that concomitant marijuana abuse played a key role in the pathogenesis of VLS.

CASE PRESENTATION: A 47 year old male with no PMH presented with 3 days of SOB, cough and fever. He has 20 pack year and 25 joint year history of smoking cigarettes and marijuana respectively. Vitals were remarkable for tachycardia, tachypnea and fever of 101.4. Exam showed left sided rales only and had leukocytosis on lab work. CXR (fig 1A) showed giant bullae on right occupying the entire lung field and left sided apical bullae and basilar opacity. CT chest ruled out tension pneumothorax (fig 1B). Community acquired pneumonia (CAP) therapy started. His alpha-1 antitrypsin levels were normal. Septic shock and worsening hypoxia ensued in next 48 hours requiring mechanical ventilation. Broad spectrum antibiotics and vasopressors were started. Repeat CT chest (fig 1C) confirmed worsening left lung consolidation. He did not improve on ARDS protocol mechanical ventilation and switched to veno-arterial ECMO due to hypoxia, septic cardiomyopathy and severe metabolic acidosis. Unfortunately, he developed DIC and went into cardiac arrest and could not be revived.

DISCUSSION: VLS is a rare condition defined as giant bullae occupying at least 1/3 hemithorax1. VLS should be differentiated from tension pneumothorax. CT is the imaging modality of choice. Bullectomy is done for symptomatic improvement but does not restore the collapsed lung in most cases.Smoking is the only known risk factor but marijuana use is emerging as a risk factor, especially, in concomitant smokers. Marijuana smoking involves a two-thirds larger puff volume, a one-third greater depth of inhalation, and four-times longer breath-holding time than tobacco smoking contributing to bullae formation2. CAP is the leading cause of ARDS with mortality of 30-50%. Theoretically, VLS can increase the morbidity and even mortality from pneumonia due to poor gas exchange and significant reduction in normal lung tissue.

CONCLUSIONS: Our case highlights the potential future complications of unchecked marijuana use with recent legitimization USA. We advice cautious use of marijuana for medicinal purposes especially current or former smokers

Reference #1: 1. Roberts L, Putman C, Chen J, Goodman L, Ravin C. Vanishing lung syndrome: upper lobe bullous pneumopathy. Rev Interam Radiol 1987;12:249.

Reference #2: 2. Golwala H. Marijuana abuse and bullous emphysema. Lung India: Indian Chest Society. 2012;29(1):56-58.

DISCLOSURE: The following authors have nothing to disclose: Faraz Siddiqui, Tahir Khan, Abul Hassan Siddiqui, Shimshon Weisel

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