Vanishing Lung Syndrome: Compound Effect of Tobacco and Marijuana Use on the Development of Bullous Lung Disease – A Joint Effort

Abstract

Marijuana use has been increasing across the United States due to its legalization as both a medicinal and recreational product. A small number of case reports have described a pathological entity called vanishing lung syndrome (VLS), which is a rare bullous lung disease usually caused by tobacco smoking. Recent case reports have implicated marijuana in the development of VLS.We present a case of a 47-year-old man, who presented to our hospital with shortness of breath, fevers and a productive cough. On physical exam, he was tachypneic with audible stridor and absent right sided breath sounds. Laryngoscopy showed a retropharyngeal abscess, and chest radiography showed a possible right pneumothorax. Chest computed tomography (CT) showed bilateral bullous emphysematous lung disease with a giant bulla occupying most of his right lung field. He was placed on mechanical ventilation and treated with broad spectrum antibiotics in the intensive care unit, where he developed acute respiratory distress syndrome (ARDS). He continued to decline, and developed disseminated intravascular coagulation, after which he succumbed to his disease.

Giant bullous emphysema mistaken for traumatic pneumothorax

“… CASE REPORT SEX AGE SYMPTOMS RISK FACTORS PNEUMOTHORAX TREATMENT BALLAY ET AL 2017 [8] WOMAN 50 DYSPNEA, CHEST PAIN TOBACCO ? SPIRATION IBV VALVES JAISWAL ET AL 2017 [18] WOMAN 48 DECREASED EXERCISE TOLERANCE TOBACCO N BULLECTOMY SAEED ET AL 2017 [19] MAN 56 DYSPNEA, CHEST PAIN TOBACCO, CANNABIS, AIDS Y HEIMLICH VALVE SHARMA ET AL 2017 [3] MAN 44 DYSPNEA, CHEST PAIN TOBACCO, CANNABIS N CLINICAL WIESEL ET AL 2017 [22] MAN 47 DYSPNEA, COUGH, FEVER TOBACCO, CANNABIS N CLINICAL ANILE ET AL 2016 [17] MAN 14 DYSPNEA, CHEST PAIN NONE N BULLECTOMY YUNHEE ET AL 2016 [5] MAN 55 DYSPNEA, COUGH TOBACCO N CLINICAL …”

Vanishing Lung Syndrome in a Young Male With Chronic Marijuana Use: A Case Report

“…VLS or type I bullous emphysema is a condition that most commonly affects people over age 45 with concomitant tobacco smoking or at an earlier age in patients with a history of alpha-1 antitrypsin deficiency and/or marijuana use [2]. Cannabis is the most widely used illicit substance in the world and the second most smoked substance after tobacco products, with emphysematous disease being more prevalent amongst marijuana smokers compared to non-smokers and tobacco-only smokers [1]. Chronic marijuana smoking can lead to parenchymal and histologic changes because of airway inflammation and irritation secondary to prolonged inhalation of toxic particles and elevated inspiratory pressures from deep inhalation.…”

“…This case describes a rare cause of emphysematous lung disease known as vanishing lung syndrome (VLS), a type I bullous emphysema or idiopathic bullous disease characterized by irreversible lung parenchymal damage resulting in giant bullous emphysema involving one or both lungs [1,2]. It is characterized as a progressive lung disease that can present with dyspnea, chest tightness, and respiratory failure due to inadequate participation in gas exchange [2,3].…”

Embolismo cerebral durante vuelo comercial: reporte de caso

“…Se ha descrito el síndrome del pulmón evanescente (Vanishing Lung Syndrome), el cual es una enfermedad rara que causa bullas pulmonares gigantes y ocupa al menos un tercio del hemitórax; usualmente se produce por fumar tabaco, aunque se han reportado casos que relacionan a la marihuana con su desarrollo e incluso como un catalizador potencial (5,8) . El paciente tenía antecedentes de estos hábitos nocivos.…”

“…La bulla gigante se define como aquella que ocupa el 30% del hemitórax, mayormente a consecuencia del tabaquismo, aunque pueden ser idiopáticas o tener otras causas (4)(5)(6) . El consumo concomitante de marihuana se ha asociado con bullas gigantes (5,7) . La prevalencia de bullas pulmonares es desconocida, aunque se describe que típicamente ocurre en los lóbulos superiores y es más frecuente en los varones (4) .…”