VAPING-INDUCED ALVEOLAR RUPTURE LEADING TO PNEUMOMEDIASTINUM IN A YOUNG FEMALE

Abstract

TOPIC: Disorders of the Mediastinum TYPE: Medical Student/Resident Case Reports INTRODUCTION: Electronic cigarette use or "vaping" has been on the rise in America over the last decade. Literature shows that approximately 8.1 million Americans admitted to vaping in 2018. Vaping is when one inhales and exhales an aerosolized solution (Vaper) through a cigarette-like electrical device. Some chemicals found in vapers have been linked to disease processes. While using E-cigarettes, the participant inhales a large amount of vaper, exaggerating the Valsalva maneuver, subsequently increasing intra-thoracic pressure. This increase in thoracic pressure places the participant at risk for spontaneous pneumomediastinum. We present a case of a 19-year-old female diagnosed with spontaneous pneumomediastinum. The only risk factor, the use of electric cigarettes. CASE PRESENTATION: A 19-year-old female with a history of type 1 diabetes mellitus and vape dependence presents with a 3-day history of abdominal pain, chest pain, and retching. She admitted to vaping daily for one year before the presentation. Physical examination revealed no evidence of respiratory distress along with slight crepitus tracheal area at the level above the clavicle. She was found to be in diabetic ketoacidosis (DKA), which was also treated. She continued to have epigastric burning along with chest pain. For this reason, computed tomography (CT) of the chest was performed and showed pneumomediastinum. She did not meet the Pittsburg criteria for esophageal rupture. Barium swallow eventually ruled out esophageal rupture. The pneumomediastinum likely occurred secondary to vape-induced alveolar rupture. She was treated with supplemental oxygen, and serial chest radiograph showed gradual resolution of pneumomediastinum. DISCUSSION: Laennec first described pneumomediastinum (PM) in 1819 as a consequence of traumatic injury. The clinical presentation could be very vague, ranging from classic chest pain to unspecific symptoms, which lead to delayed diagnosis. The pathophysiology of can be described by the Macklin effect as follows: (a) alveolar rupture, (b) air dissection along the bronchovascular sheath, and (c) free air reaching the mediastinum. Chest radiography, the standard diagnostic procedure, diagnosis can be confirmed by chest computed tomography scan. Once the diagnosis is approved, the patient should be admitted for monitoring and treatment consisting of avoidance of the trigger factors, oxygen, and bed rest. CONCLUSIONS: Spontaneous pneumomediastinum secondary to vaping is on the rise. The diagnosis of vaping-induced lung injury continues to be a dilemma among physicians. A high index of suspicion is necessary for early detection and treatment. Although most cases are benign, it will be prudent for health care providers to actively query patients about their use and educate patients on their potential severe side effects. REFERENCE #1: Pneumomediastinum: Practice Essentials, Pathophysiology, Epidemiology. Accessed April 28, 2021. https://emedicine.medscape.com/article/1003409-overview REFERENCE #2: Marasco RD, Loizzi D, Ard NP, Fatone FN, Sollitto F. Spontaneous Pneumomediastinum After Electronic Cigarette Use. Ann Thorac Surg. 2018;105:e269-e271. doi:10.1016/j.athoracsur.2017.12.037 REFERENCE #3: Panacek EA, Singer AJ, Sherman BW, Prescott A, Rutherford WF. Spontaneous pneumomediastinum: Clinical and natural history. Ann Emerg Med. 1992;21(10):1222-1227. doi:10.1016/S0196-0644(05)81750-0 DISCLOSURES: No relevant relationships by Esiemoghie Akhigbe, source=Web Response No relevant relationships by Ebubechukwu Ezeh, source=Web Response No relevant relationships by Mackenzie Hamilton, source=Web Response No relevant relationships by Mohamed Suliman, source=Web Response