Case:
A 15-year-old female with a significant past medical history of recurrent spontaneous pneumothorax presents as a direct admission after development of sudden onset left-sided chest pain with radiation into her left shoulder. Her pain is worse with deep inspiration, and she endorses a bubbling feeling below her ribs with associated numbness and tingling of the left upper extremity. She denies recent illness, preceding trauma, or history of connective tissue disease. Family history is non-contributory, and social history is positive for daily e-cigarette use containing nicotine and cannabinoid cartridges.
Initial workup with an electrocardiogram reveals normal sinus rhythm. A viral respiratory panel, which includes the novel SARS-CoV-2, is negative, and complete blood count and basic metabolic panel is normal. Chest x-ray (figure 1) performed on admission reveals a small to moderate left-sided pneumothorax. Further analysis with CT chest (figure 2) is performed and only demonstrates the pneumothorax. This is the third episode of pneumothorax in this patient within the past 6 months. Figure 3 shows her chest radiograph from initial hospitalization. She is placed on 100% FiO2 via non-rebreather for nitrogen washout. Pediatric pulmonology and cardiothoracic surgery are consulted. Given her history of recurrent pneumothoraces, the patient is planned to have a left sided partial pleurectomy, blebectomy, and mechanical pleurodesis via video assisted thorascopic surgery (VATS). A chest tube is inserted intraoperatively and maintained on negative pressure. Oxygen is weaned to room air, and her chest tube is placed to water seal. Three days post-operatively, she remains clinically stable and the chest tube is removed. Follow-up imaging is stable with minimal residual pneumothorax. Extensive counseling during the admission is provided to the patient and family regarding cessation of vaping to minimize the risk of recurrence.