Case Presentation: This is a case of a 24 year old male with a past medical history of seizure disorder presented to the emergency room with a complaint of retrosternal chest pain which was worse with inspiration which started in the morning while he was smoking his electronic cigarette. Workup in the emergency room included a chest X-ray initially which was not indicative of pneumothorax, but the patient was lying down at the time, interfering with diagnosis. Subsequently a CT angio of the chest was ordered, portraying left-sided small to slightly moderate pneumothorax and paraseptal and centrilobular emphysematous changes within the upper lobe base on the right side. A lateral chest tube was placed on the left side for one day and repeat imaging revealed improvement of the pneumothorax. The chest tube was removed and the patient was clinically stable for discharge. The patient was counseled extensively on the importance of discontinuing all tobacco and marijuana products including electronic cigarettes as he was already showing signs of emphysema in addition to the acute pneumothorax.
Discussion: The rise of electronic cigarette use, particularly among adolescents and young adults, has introduced a rise of pulmonary health risks. Marketed as a safer alternative to traditional tobacco products, e-cigarettes and vaping devices have rapidly gained popularity despite limited long-term safety data. Recent evidence, however, has linked vaping with acute lung injury, chronic respiratory symptoms, and even early-onset lung disease. Spontaneous pneumothorax, traditionally associated with tall, thin young males or individuals with underlying lung pathology, has been increasingly reported in those that vape, especially with concurrent marijuana use. Additionally, early emphysematous changes, usually rare in otherwise healthy young adults, are now being identified on imaging in patients with a history of regular e-cigarette use.
Conclusions: This case illustrates the concerning and increasing amount of pulmonary complications associated with electronic cigarette (vaping) use in young adults. Our patient, a 24 year old male, with no significant history of lung disease presented with spontaneous pneumothorax and radiographic evidence of early emphysematous changes. These changes are particularly alarming given his young age and direct correlation with his ongoing use of e-cigarettes and marijuana products. This case underscores the critical need for early screening, education, and counseling in young adults who use vaping products. Despite common misconceptions, these substances are not benign, and early lung damage may be irreversible. The incidental finding of emphysematous changes in this patient offers opportunity for intervention before the development of chronic obstructive pulmonary disease or recurrent pneumothoraces.