THE “MASS” PRODUCTION OF MARIJUANA

Abstract

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Marijuana smoking is associated with various forms of acute and chronic lung injury with radiological findings ranging from diffuse alveolar hemorrhage to paraseptal emphysema.[1] These effects may be attributed to marijuana usage habits which include increased inhalation volumes, depths of inhalation, and breath-holding times.[1] Such maneuvers have increased risk of subpleural blebs and emphysematous changes compared to tobacco inhalation alone.[1] We report the finding of post traumatic hemorrhage into paraseptal emphysema in a chronic marijuana smoker mimicking a mass. CASE PRESENTATION: A 41-year-old male patient with history of extensive marijuana smoking presented complaining of cough. Two weeks prior, patient was in a motorbike accident. He was found to have bilateral pneumothoraces, multifocal pulmonary contusions, renal lacerations with perirenal hematoma, and multiple rib fractures requiring bilateral chest tubes. Chest radiograph 2 weeks later showed multiple lung masses. CT chest confirmed multiple lobular, soft tissue density masses in the periphery of the left lung. DISCUSSION: Inhalational marijuana use has a wide spectrum of presentation in the acute and chronic setting. Marijuana usage is associated with increased cough, sputum production, dyspnea, and wheezing.[1] Chronic use can result in emphysema, subpleural blebs, and lung cancer[1,2] The risk of lung cancer increases 8% for each joint year of cannabis smoking after adjusting for confounding variables including cigarette smoking.[2] The blebs and bullous disease from marijuana smoking may result in spontaneous pneumothoraces, pneumomediastinum, and alveolar hemorrhage in the acute setting.[1] In our case, mass-like lesions presented a broad differential diagnosis which included septic emboli, lung cancer (primary or metastatic), and infectious nodules. However, these masses were confirmed to have an acute onset and were not present on imaging from two weeks prior making lung cancer less likely. The masses also have the density of blood suggesting blood-filled bullae. These bullae could also be post-traumatic pneumatoceles, which have thin walls with fully circumferential lung parenchyma.[3] However, the bullae in this patient did not have surrounding lung parenchyma, favoring emphysematous changes secondary to marijuana. Overall, these findings are consistent with paraseptal hemorrhage into marijuana-induced emphysematous blebs. CONCLUSIONS: The occurrence of these unusual masquerading “masses” should be considered a deleterious structural effect of chronic marijuana smoking on pulmonary parenchyma. With the increasing popularity of marijuana as a result of its legalization, it is important that clinicians stay up to date with the pulmonary sequelae of inhalational marijuana use. Reference #1: Golwala, H. (2012). Marijuana abuse and bullous emphysema. Lung India, 29(1), 56-58. https://doi.org/10.4103/0970-2113.92365 Reference #2: Aldington, S., Harwood, M., Cox, B., Weatherall, M., Beckert, L., Hansell, A., . . . Respiratory Disease Research, G. (2008). Cannabis use and risk of lung cancer: a case-control study. Eur Respir J, 31(2), 280-286. https://doi.org/10.1183/09031936.00065707 Reference #3: Quigley, M. J., & Fraser, R. S. (1988). Pulmonary pneumatocele: pathology and pathogenesis. AJR Am J Roentgenol, 150(6), 1275-1277. https://doi.org/10.2214/ajr.150.6.1275 DISCLOSURES: No relevant relationships by Crystal Duran, source=Web Response No relevant relationships by Corey Garvin, source=Web Response No relevant relationships by jayanth keshavamurthy, source=Web Response No relevant relationships by Yasasvi Tadavarthi, source=Web Response No relevant relationships by Varsha Taskar, source=Web Response