9th March 2018, Volume 131 Number 1471

Kate Grant, Vivienne Campbell, Lutz Beckert

A 34-year-old man presented with two weeks of cough, unrelenting rib pain and shortness of breath. He has smoked three joints per day for seven years and also has a 12-pack year history of cigarette smoking.

His CT-chest revealed four distinct pathologies relating to his cannabis and cigarette smoke exposure: a) pneumothorax, b) emphysematous bulla, c) primary bronchogenic carcinoma and d) a rib metastasis.

The medicinal properties of cannabis are currently being re-evaluated and the clinical evidence is still evolving. However, cannabis smoking has been linked to an increased risk of lung cancer. One joint of cannabis has a similar toxic effect to one packet of cigarettes.1 Heavy cannabis smoking is also associated with lung bullae2 and an increased risk of pneumothoraces.3

Figure 1: 

c 

Figure 2: 

c 

Author Information

Kate Grant, Respiratory House Officer, Department of Respiratory Medicine, Canterbury District Health Board, Christchurch; Vivienne Campbell, Respiratory Registrar, Department of Respiratory Medicine, Canterbury District Health Board, Christchurch; Lutz Beckert, Respiratory Physician, Department of Respiratory Medicine, Canterbury District Health Board, Christchurch.

Correspondence

Professor Lutz Beckert, Respiratory Physician, Department of Respiratory Medicine, Canterbury District Health Board, Christchurch 8140.

Correspondence Email

lutz.beckert@cdhb.health.nz

Competing Interests

Nil.

References

  1. Aldington S, Harwood M, Cox B, Weatherall M, Beckert L, Hansell A, et al. Cannabis use and risk of lung cancer: a case-control study. Eur Respir J. 2008 Feb; 31(2):280–6.
  2. Johnson MK, Smith RP, Morrison D, Laszlo G, White RJ. Large lung bullae in marijuana smokers. Thorax. 2000 Apr; 55(4):340–2.
  3. Beshay M, Kaiser H, Niedhart D, Reymond MA, Schmid RA. Emphysema and secondary pneumothorax in young adults smoking cannabis. Eur J Cardiothorac Surg. 2007 Dec; 32(6):834–8.