Abstract Introduction Primary spontaneous pneumothorax (PSP) typically affects tall, thin young men and has long been linked to cigarette smoking. Recent evidence, however, implicates both vaping and marijuana inhalation as additional risk factors. The exposure to heated aerosols and chemical vapors can injure alveolar structures, contributing to bleb development and predisposing the lung to collapse.¹1³ We describe a patient who developed recurrent, bilateral spontaneous pneumothoraces following heavy e-cigarette and marijuana use. Case Description A 30-year-old male with a daily habit of vaping and marijuana consumption presented with sudden-onset dyspnea and pleuritic chest pain. One month earlier, he had sustained a right-sided pneumothorax treated with chest tube drainage but resumed vaping after recovery. Imaging revealed a large right pneumothorax (approximately 70-80% collapse) and a smaller left-sided pneumothorax (20-30%). Bilateral chest tubes were placed for decompression. He later underwent right-sided video-assisted thoracoscopic surgery (VATS) with apical bleb resection and both mechanical and talc pleurodesis, with plans for a staged procedure on the opposite side. Laboratory studies, including alpha-1 antitrypsin level (189 mg/dL), were normal. Aside from a low BMI (17.8 kg/m²) and ongoing vaping, no additional risk factors were identified. Discussion Both vaping and marijuana smoking have been increasingly recognized as potential precipitants of PSP. Repeated exposure to heated hydrocarbons and fine particulates may provoke oxidative damage, inflammation, and alveolar disruption, ultimately fostering bleb or bullae formation.1-4 Deep inhalation techniques and breath-holding commonly associated with marijuana use may further increase intrathoracic pressure, promoting apical bullae formation and subsequent rupture.5-7 Definitive management of recurrent or bilateral PSP often requires surgical intervention—most effectively, VATS with blebectomy and pleurodesis—to prevent recurrence. This case highlights the growing concern that vaping and marijuana use can contribute to severe pulmonary complications in young adults. Comprehensive cessation counseling and close follow-up are essential to mitigate recurrence risk and improve clinical outcomes. References 1.Sharma A, et al. Cureus. 2019;11(12):e6304. 2.Bonilla A, et al. J Med Case Rep. 2019;13(1):283. 3.Skertich NJ, et al. J Pediatr Surg Case Rep. 2019;47:101209. 4.Brashier B, et al. J Clin Med. 2022;11(15):4352. 5.Bense L, et al. Respir Med. 2018;137:123-128. 6.Hedevang O, et al. Eur J Cardiothorac Surg. 2017;52(4):679-685. 7.Ribeiro LI, et al. Breathe (Sheff). 2016;12(3):222-230. This abstract is funded by: None
Fattouhi et al. (Fri,) studied this question.