Shah A, Paramlal M
Department of Respiratory Medicine, West Middlesex University Hospital, Uxbridge, UK.
BMJ Case Rep. 2011 Jun 30;2011:bcr0120113693. doi: 10.1136/bcr.01.2011.3693.
The authors present the case of a 27-year-old man who presented with acute left-sided pleuritic chest pain and dyspnoea managed as for a spontaneous pneumothorax with aspiration and subsequent chest drain insertion following a chest radiograph. Despite intervention, however, his chest radiograph showed what appeared to be a non-resolving pneumothorax. Further history revealed a large cannabis smoking exposure and subsequent CT imaging revealed large apical bullous disease with little residual pneumothorax. The patient was referred for cardiothoracic bullectomy and pleurodesis. The authors review the association between cannabis smoke inhalation and apical bullous lung disease and stress the importance of direct questioning on initial history. If a significant history is found, the authors argue that CT imaging and primary cardiothoracic intervention may then be the investigation and management of choice in a stable patient.
作者报告了一例27岁男性病例，该患者因急性左侧胸膜炎性胸痛和呼吸困难就诊，最初按照自发性气胸进行处理，予以胸腔穿刺抽吸，随后根据胸部X线片结果插入胸腔引流管。然而，尽管进行了干预，其胸部X线片显示气胸似乎未得到缓解。进一步询问病史发现患者有大量吸食大麻史，随后的CT成像显示肺部尖部有大疱性病变，气胸残留较少。该患者被转诊接受心胸外科肺大疱切除术和胸膜固定术。作者回顾了吸食大麻与肺部尖部大疱性疾病之间的关联，并强调在初次问诊时直接询问相关病史的重要性。作者认为，如果发现有重要的相关病史，对于病情稳定的患者，CT成像和心胸外科的初步干预可能是首选的检查和治疗方法。
