BILATERAL SPONTANEOUS PNEUMOTHORAXES ASSOCIATED WITH VAPING

TOPIC: Tobacco Cessation and Prevention TYPE: Medical Student/Resident Case Reports INTRODUCTION: Electronic cigarette or vaping product use associated lung injury (EVALI) has received increasing attention by the Centers for Disease Control (CDC) within last year due to a recent increase of cases acute with vaping. The CDC established criteria EVALI: 1) patient must have vaped 90 days prior symptom onset; 2) there is evidence pulmonary infiltrate on chest radiographs CT; 3) absence infection initial work-up; 4) no alternative diagnoses.Spontaneous pneumothoraces (SPs) are often idiopathic in nature, classically tall, thin males between ages 15-34 years old, as well underlying connective tissue diseases. There few reported SPs association e-cigarette use, bilateral being nearly unseen. CASE PRESENTATION: A 26-year-old Caucasian male past medical history polysubstance abuse presented emergency department one-day shortness breath pain. He was an active daily vaper. On arrival, he endorsed dyspnea, hemoptysis, presyncope, pleuritic Vitals showed hypotension, tachycardia, tachypnea. Physical exam shows trauma tracheal deviation. Lung sounds were decreased at both apices. Chest X-ray apical pneumothoraces. Workup respiratory virus panel COVID negative. CBC CMP lab values largely unremarkable, only lactic acidosis 4.4 mmol/L. Toxicology positive cocaine, THC, opiates. left sided thoracostomy performed, resulting resolution pneumothorax. Shortly after placement, traumatically removed his tube. 100% oxygen resulted right downgraded from ICU discharged hospital day three symptoms. DISCUSSION: Spontaneous pneumothorax potentially life-threatening condition. This patient's concerning presentation spontaneous secondary (SBSP) multifocal opacities x-ray setting vape without family disease, created clinical picture. EVALI already Per January 14, 2020, 2,668 requiring hospitalization, 68 mortality CONCLUSIONS: case highlighted order add dangerous effects Patients should be counseled wide variety risks Furthermore, SBSP quite rare, this makes marijuana most likely contributing factors presentation. monitored over time recurrences cessation. REFERENCE #1: Outbreak Injury Associated Use E-Cigarette, Vaping, Products. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html #2: Graf-Deuel E, Knoblauch A: Simultaneous Chest. 1994, 105:1142-1146. 10.1378/chest.105.4.1142 DISCLOSURES: No relevant relationships Riley Ewen, source=Web Response Gilad Guez, disclosure file Brijesh Patel; Farhan Shah