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• W3093128158 abstract "SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: With the advent of vaping popularity in the general population, there has been a nationwide incidence of novel Electronic Vaping Related Lung Injuries (EVALI) reported across all age groups (1). Often these patients present to emergency departments (ED) with primarily pulmonary symptoms. According to emerging reports, the majority of EVALI patterns have shown basilar predominant consolidation and ground glass opacity (2). This case, however, presents asymptomatically with sub-pleural and parenchymal blebs. CASE PRESENTATION: A thirty-one year old male with a history of alcohol abuse and recurrent pancreatitis presented to the ED with worsening abdominal pain. He was admitted for acute on chronic pancreatitis. He endorsed drinking ½ liter of rum daily for the past 2 years, but stated he quit 5 months earlier. He endorsed current marijuana smoking and daily hourly vaping. He was a past 6 pack-year smoker, quitting 5 years ago. Physical examination was only notable for right upper quadrant and epigastric tenderness. In the ED a CT abdomen/pelvis was completed, which incidentally showed large paraseptal bulla along the anteromedial pleura, the largest measuring approx. 7.1x7.8 cm but not fully visualized. A CT Chest was completed showing multiple paraseptal bulla and subpleural blebs. Further history was then obtained. He denied any respiratory symptoms such as dyspnea, chest pain, shortness of breath, cough, sputum production or exertional limitations. He is employed as a robotic technician, previously in the military, but denies any toxic exposures. He was unable to quantify his marijuana use history, but stated he previously smoked daily but had begun to slowly taper over the past 3 years and is currently only smoking marijuana occasionally. He endorses vaping hourly for the past 2 years with nicotine oils. Studies were sent including Alpha 1 Antitrypsin, IgG4, Anti-CCP, Sjogrens, and Quantiferon Gold, all of which resulted as negative. Throughout the hospital course, the patient remained asymptomatic from a respiratory perspective and was discharged with close follow up after extensive counseling on the need to quit vaping and marijuana use. DISCUSSION: While a majority of reported EVALI cases present with ground glass opacities and pulmonary symptoms this case may suggest the presentation of EVALI overlap with frequent marijuana smoking as well as a past history of frequent tobacco smoking. This case presents with what is assumed to be asymptomatic emphysematic changes to the lung parenchyma that are hastened by superimposed electronic vaping. CONCLUSIONS: This asymptomatic presentation suggests that there may be other manifestations of EVALI due to concomitant factors. It shows that a thorough history taking to find potential overlap in risk factors for lung injury are accounted for and a high level of suspicion should accompany patients with multiple lung injury risk factors. Reference #1: Hartnett, Kathleen P., et al. “Syndromic Surveillance for E-Cigarette, or Vaping, Product Use–Associated Lung Injury: NEJM.” New England Journal of Medicine, 29 Jan. 2020, www.nejm.org/doi/full/10.1056/NEJMsr1915313. Reference #2: Christiani, D.C., et al. “Imaging of Vaping-Associated Lung Disease: NEJM.” New England Journal of Medicine, 6 Sept. 2019, www.nejm.org/doi/full/10.1056/NEJMc1911995. DISCLOSURES: No relevant relationships by Sarah Bjork, source=Web Response No relevant relationships by Doha Ghanim, source=Web Response No relevant relationships by Fastina Khan, source=Web Response No relevant relationships by Kinjal Patel, source=Web Response" @default.
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• W3093128158 date "2020-10-01" @default.
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• W3093128158 title "ASYMPTOMATIC BULLAE FORMATION IN CHRONIC MARIJUANA AND ELECTRONIC VAPING USE" @default.
• W3093128158 doi "https://doi.org/10.1016/j.chest.2020.08.1445" @default.
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