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.
Highlights
Vanishing lung syndrome (VLS) is a radiographic entity first described in 1987 as giant bullae displacing normal lung tissue and occupying at least one-third of the hemithorax
VLS is usually associated with smoking tobacco, but marijuana has been implicated in recent literature
Misconception about the harmlessness of marijuana should be a public health awareness issue. We highlight this point by presenting a rare case of VLS in a marijuana user, complicated by acute respiratory distress syndrome (ARDS), with a brief literature review on the contribution
Summary
Vanishing lung syndrome (VLS) is a radiographic entity first described in 1987 as giant bullae displacing normal lung tissue and occupying at least one-third of the hemithorax. A previously healthy 47-year-old man presented to the emergency department with a three-day history of shortness of breath, productive cough with yellow sputum, and fevers He had a 20 pack-year and 25 joint-year history of smoking cigarettes and marijuana, respectively. Repeat CT chest showed worsening left lung consolidation consistent with ARDS (Figures 4-5). He showed no signs of improvement on mechanical ventilation requiring 100% FiO2. Veno-arterial extracorporeal membrane oxygenation (ECMO) was initiated due to severe refractory hypoxemia, septic cardiomyopathy, and severe metabolic acidosis He developed disseminated intravascular coagulation (DIC), went into cardiac arrest and could not be revived. Lung parenchyma is not apparent in the right hemithorax consistent with pneumothorax (black arrows) This is bullous disease occupying most of the right hemithorax. Shown is left-sided consolidation with minimal right-sided consolidation consistent with ARDS (black arrows)
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