A Fatal Complication of Marijuana!

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complication of marijuana
CXR showing right pneumothorax with collapsed lung

A 39-year-old smoker and illicit drug abuser presented with a life-threatening complication. A case reflecting light on a complication of marijuana!

The number of marijuana users is increasing day by day. With many states legalizing the use of marijuana, the abuse/use is bound to increase. However, it won’t be without excess baggage. The complications related to marijuana and the hospital admission/clinic visits for the evaluation and management of side effects are rising. Some adverse effects are benign and manageable, while others are life-threatening. Here is a case presentation revealing a fatal complication of marijuana.

Clinical Case:

Paramedics brought a 39-year-old African American male patient to the emergency department with complaints of sudden-onset of sharp right-sided chest pain. The patient developed pain suddenly after a coughing spell while he was smoking marijuana. Moreover, he also had shortness of breath along with pain.

There was no history of any physical trauma or injury. However, three months back, he had developed pneumothorax, which the doctors managed by thoracostomy tube. However, definitive surgical management had to be delayed due to coronavirus pandemic. The rest of the surgical, psychiatric, and family history was unremarkable. However social history was significant for daily marijuana use and tobacco smoking.

Examination in the emergency department revealed normal vitals. His oxygen saturation was 96% on 2 litres by nasal cannula. However, auscultation of the chest revealed diminished air entry on the right side of the chest. Also, chest percussion revealed hyper resonance on the right side.

Plain radiograph of the chest (CXR) showed a large, potentially life-threatening, right-sided pneumothorax affecting 50%-60% of the lung.

Although the doctors inserted a chest tube and placed it on suction with persistent air leak, the repeat CXR still revealed an incomplete lung expansion.

Moreover, the computed tomography scan (CT) of the chest also demonstrated extensive bilateral apical bullous emphysema.

Complication of marijuana
Computed tomography scan showing extensive bilateral apical emphysema, right pneumothorax, and consolidation of the right lung lobe
Complication of marijuana
Axial view of chest CT scan

The patient underwent a video-assisted thoracoscopic surgery (VATS) for blebs stapling and pleurodesis.

A repeat CXT after the surgery showed successful re-expansion of the lungs. Since the patient had recovered well, he was discharged with advice to follow up in the outpatient after smoking cessation counselling.

Post Surgical CXR

References:

Aboulenain S, Dewaswala N, Bhopalwala H, Isaac S (2020) Recurrent Spontaneous Pneumothorax Secondary to Marijuana-Induced Extensive Bullous Emphysema. Int J Respir Pulm Med 7:141. doi.org/10.23937/2378-3516/1410141

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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