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• W2894915332 abstract "SESSION TITLE: Lung Pathology 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: A rare but serious complication of incentive spirometer use in the setting of damaged lung parenchyma in the development of secondary pneumothorax. CASE PRESENTATION: A 23-year-old hispanic male with a past medical history of TxN2S3 nonseminomatous left testicular cancer, treated with chemotherapy, presented to the emergency department with two days of hemoptysis. Social history was remarkable for daily inhaled marijuana use. CT scan of the chest revealed bilateral upper and lower lobe cavitary lung lesions, and patient was started on intravenous antibiotics for necrotizing pneumonia. Bronchoscopy with bronchoalveolar lavage revealed cultures positive for Klebsiella pneumoniae. After showing clinical improvement on hospital day 7, patient was discharged home on a course of ciprofloxacin with close follow-up. Patient presented 10 days later to the emergency department with acute, sharp, left-sided chest pain induced by incentive spirometer use at home. He remained hemodynamically stable. Physical exam revealed absent left-sided lung sounds without evidence of tracheal deviation. Chest x-ray showed moderate left-sided pneumothorax. Chest tube thoracostomy was performed with successful lung re-expansion. Repeat CT of the chest showed worsening necrotizing pneumonia and intravenous antibiotics were reinitiated. Removal of chest tube on hospital day 3 was complicated by recurrence of pneumothorax requiring tube reinsertion. Patient was discharged home with the chest tube in place which was successfully removed 3 weeks later following resolution of the infection and further healing of lung parenchyma. Repeat CT chest one month later showed improvement of lung consolidation and cavitation. DISCUSSION: This case illustrates a severe complication from incentive spirometry use in the setting of compromised lung parenchyma due to a necrotizing pneumonia and chronic marijuana use. Necrotizing pneumonia is defined as pulmonary inflammation with consolidation, peripheral necrosis, and multiple small cavitary lesions (<1cm); Most commonly caused by Streptococcus pneumoniae and less commonly, Klebsiella pneumoniae. Recreational marijuana use is a risk factor for structural damage to lung tissue via increased barotrauma from smokers inhaling deeply and holding their breaths to facilitate diffusion of psychoactive chemicals. Incentive spirometry is a common method used to facilitate increased pulmonary functionality by opening alveoli, reducing atelectasis, and promoting secretion removal. This device is often considered harmless, however, can contribute to development of spontaneous pneumothorax in patients with significant underlying lung damage. CONCLUSIONS: Patients that may be at high risk for adverse events with incentive spirometer use should be identified early and counseled to seek immediate medical attention if they develop worsening of their respiratory symptoms or chest pain following use. Reference #1: Chatha N, Fortin D, Bosma KJ. Management of necrotizing pneumonia and pulmonary gangrene: a case series and review of the literature. Can Respir J. 2014;21:239–245 Reference #2: Lee MH, Hancox RJ. Effects of smoking cannabis on lung function. Expert Rev Respir Med. 2011;5(4):537-546 Reference #3: Kenny, J.E., Kuschner, W.G. Pneumothorax caused by aggressive use of an incentive spirometer in a patient with emphysema. Respir Care. 2013;58:e77–e79 DISCLOSURES: No relevant relationships by Ebone Hill, source=Web Response No relevant relationships by Stephanie Hudey, source=Web Response No relevant relationships by Matthew Liu, source=Web Response" @default.
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• W2894915332 date "2018-10-01" @default.
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• W2894915332 title "TAKE MY BREATH AWAY: A CASE OF SECONDARY PNEUMOTHORAX CAUSED BY INCENTIVE SPIROMETER USE IN THE SETTING OF NECROTIZING PNEUMONIA" @default.
• W2894915332 doi "https://doi.org/10.1016/j.chest.2018.08.633" @default.
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