Interfaith Medical Center, Brooklyn, NY
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Fellow Case Report Poster - Obstructive Lung Disease
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM
INTRODUCTION: Cannabis is the most commonly used recreational drug in the United States. Its abuse has been associated with Coronary thrombosis, Myocardial Infraction (MI), Ischemic stroke and central retinal vein thrombosis. We report a case of Sub-massive Pulmonary Embolism (PE) in a young male following heavy cannabis smoking.
CASE PRESENTATION: 35-year-old Male with history of Schizophrenia presented to ER with worsening pleuritic chest pain, SOB and pain in the right leg for few days. Other review of systems was negative. He was incarcerated for last 16 months and was released 2 weeks prior to presentation. He was smoking cannabis heavily since his release. Physical examination was unremarkable except for tachycardia and initial labs showed troponin 0.16, BNP 419 and respiratory alkalosis. Urine toxicology was positive for cannabinoids. EKG revealed sinus tachycardia with T wave inversion in lateral leads. Chest X-Ray was unremarkable. CT chest revealed multiple large bilateral emboli and Echo showed right heart strain with moderate pulmonary hypertension. In next 24 hours he was hemodynamically unstable in respiratory distress requiring 10 Litre oxygen. He underwent catheter directed thrombolysis and was symptomatically better.the following day. Right pulmonary artery pressure decreased from 68/26 to 34/13. Duplex of leg veins showed a thrombus in right popliteal vein. Patient had no obvious risk factors for VTE. All workup for hypercoagulability was negative.
DISCUSSION: Cannabis abuse has been associated with MI, Ischemic stroke, and Central retinal vein thrombosis in young patients. It is also known to trigger thrombosis in women using oral contraceptive pills. Cannabis induced VTE has not been reported except one case of PE in a young male. The exact mechanism by which cannabis induces hypercoagulability and thrombosis is still not well known. Some studies have reported that Cannabinoids, the active component of cannabis causes endothelial cell disruption leading to vascular thrombosis. In our case, cannabis in association with tobacco was the only risk factor, which we believe was the potential trigger that increased the risk of VTE.
CONCLUSIONS: We illustrate a cause of VTE that mostly will be overlooked. Given the prevalence of cannabis use clinicians should consider it in their differential in a thrombotic event especially in young patients.
Reference #1: Tatli, E et al Cannabis induced coronary artery thrombosis and acute anterior myocardial infarction in a young man.Int J Cardiol. 2007 Sep 3;120(3):420-2.
DISCLOSURE: The following authors have nothing to disclose: Divya Salhan, Omar Abdulfattah, Sasmit Roy, Saroj Kandel, Chidozie Agu, Md Basunia, Danilo Enriquez, Joseph Quist, Frances Marie Schmidt
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