Introduction Spontaneous pneumothorax is a condition that commonly affects young adults who may not have underlying lung diseases. There are several well-known risk factors contributing to the onset of spontaneous pneumothorax. They include cigarette smoking, particularly among adolescents and young male adults with lean physique. While smoking is a recognized risk factor for spontaneous pneumothorax, there is limited understanding regarding the role of electronic cigarettes (e-cigarettes) in its development (1, 2, 3, 4, 5). Currently, the use of e-cigarettes has surged to epidemic proportions, particularly in the younger population, with about 21% of high school students and 5% of individuals aged 18–34 reported to be users. While the long-term health implications of e-cigarettes remain unclear, there is growing concern over acute adverse effects associated with vaping. Although there have been various presentations of pneumonitis linked to vaping, cases involving pneumothorax complications remain sparse in existing literature (1, 2, 4, 6). Here we describe a case of a 25-year-old old male, who presented with a large, left – sided pneumothorax following the use of a vaping device.

Case Report A 25-year-old male with a past medical history of attention-deficit and hyperactivity disorder presented to the hospital with a complaint of increasing shortness of breath. He reported that he was sitting in a chair, talking to his friends and vaping the day before presenting to the emergency department (ER). Suddenly, he felt sharp pain in the middle of his chest, radiating to his left side. He also experienced a tightness in his ribs followed by trouble breathing. Even though the patient was able to sleep that night, he noticed that his symptoms became progressively worse. The progression prompted him to come to the ER. Upon detailed questioning, the patient reported a history of smoking cigarettes and vaping since he was 16 years old. He quit smoking cigarettes at the age of 20. Interestingly, around the time he quit smoking cigarettes, he presented to the ER with the complaint of progressive substernal chest pain. However, a CT chest at that time did not show anything of significance, including bullous or parenchymal lung disease. Though he quit smoking cigarettes, he continued vaping. He reported working as a waiter which he found to be very stressful; this led him to vape constantly throughout the day. At the exact time of chest pain onset significant to this case report, he was doing nothing other than sitting comfortably in a chair vaping; he was not experiencing stress at that present moment. It is also pertinent to include that during history taking, the patient reported no family history of pulmonary disease. Despite being 6 feet and 2 inches tall, he is the shortest amongst his brothers. Due to his tall and slender physique, he was tested for Marfan syndrome as a teenager; results were negative. The patient also reported a sedentary lifestyle with frequent social alcohol use. The patient went on to be admitted to the hospital. During his stay, a chest x-ray revealed a large, left pneumothorax measuring about 50%. Appropriate treatment was promptly initiated, including fluoroscopic guided chest tube placement. Over the next few days, the pneumothorax resolved without any complications. The patient was discharged home and subsequently quit using e-cigarettes.

Discussion E-cigarettes were introduced to the United States market in the early 2000s. Since then, their usage has seen a significant rise. This increase can be attributed to the perception that e-cigarette users are spared from the traditional harmful effects associated with smoking cigarettes. Particularly among young adults, the adoption of vaping has grown sharply over the past decade (1). Pneumothorax refers to the presence of air in the pleural space, which potentially leads to partial or complete lung collapse. It is characterized by the presence of air buildup in the pleural space, typically resulting from the rupture of subpleural blebs or bullae. Pneumothorax is broadly categorized as either traumatic or spontaneous. Spontaneous pneumothorax typically affects tall, slender males aged 10 to 30. Historically, cigarette smoking has been linked to an increased pneumothorax risk, and emerging evidence suggests that e-cigarettes may carry similar risks. The rise in e-cigarette use, especially among adolescents, has accompanied the increase in lung injuries, including pneumothorax (3, 6). While e-cigarettes have been marketed as less harmful to lung tissue compared to traditional smoking, the increasing incidence of associated E-cigarette or Vaping Product Use-Associated Lung Injury suggests otherwise. It is hypothesized that e-cigarette use may augment pneumothorax risk through physiological mechanisms and exposure to the inhaled toxins. Pneumothorax often stems from the spontaneous rupture of subpleural blebs or bullae, or increased pleural porosity due to inflammation. In the case of e-cigarette use, this could be exacerbated by inhaled nicotine and other compounds linked to lung cell damage and inflammation (1, 4). Additionally, repeated inhalation through e-cigarette devices may create significant negative intrathoracic pressure swings, leading to airway barotrauma and lung collapse (4). In our case report, we demonstrated a unique and rare association between vaping and pneumothorax. We uncovered a direct link between the time of e-cigarette use and the onset of respiratory symptoms related to pneumothorax in the patient. While the exact pathophysiology of vape-associated spontaneous pneumothorax remains unclear, it is crucial to raise awareness among healthcare providers and the general population, particularly adolescents, about the potential complications of vaping. Further investigation into vaping-related risk factors is warranted.

Conclusion In the setting of e-cigarette use being on the rise, further investigation into its effects is needed, especially with its popularity growing in such young populations. While the long-term sequelae of vaping remain unknown, healthcare professionals need to be aware of vaping as a risk factor for pneumothorax. This association that has been supported through the case of this 25-year-old sheds light on the importance of collecting vaping history during patient interviews. Furthermore, the purpose of this report is to bring attention to risk factors that may be attributed to vaping; just one of which is spontaneous pneumothorax.

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