Initially, a total of 99 reviews or case reports that had the term “computed tomography” along with the term “cannabis” or “marijuana” were surveyed in the PubMed database. All studies not related to lung analysis (83) or in non-English language (5) were excluded, leaving a total of 11. We chose not to use the important review study by Lee & Hancox (2011) because reported results for chest computed tomography lack discernment of cannabis load in many cases.
All 14 cases found, presented in table 1, were male. Their average age was 36.8 years (minimum 20, maximum 54, mode and median 35 years). In only 3 cases it was known that the patient was not a tabagist, and the average smoking load was 13.8 packs-year. As for the cannabis load only 5 had the value at work and the average was 50 joint-year.
In only 3 cases there were no reports of paraseptal emphysema or blisters, namely: the 20-year-old patient who presented with spontaneous pneumomediastinum, the 38-year-old and 54-year-old patient who presented alveolar hemorrhage without other alterations. All three had no changes in lung structure or defined cannabis load.
Three other cases had VLS, with their cannabis and smoking loads respectively 60 and unknown, unknown and 15 and 25 and 30.
Table 1. Cases surveyed and their respective CT findings.
Article (DOI) |
Gender |
Age |
Joint-year |
Tabagism |
CT Findings |
10.1016/s0221-0363(07)89836-2 |
M |
20 |
N/A |
N/A |
Subcutaneous emphysema and pneumomediastinum |
10.1111/j.1440-1673.2005.01472.x |
M |
26
|
50 |
10 pack/yr |
Diffuse pulmonary fibrosis, blisters and cysts |
10.1136/thorax.55.4.340 |
M |
27 |
N/A |
15 pack/yr |
Blisters |
10.1097%2FMD.0000000000006917 |
M |
30 |
N/A |
No |
Paraseptal emphysema and pneumothorax |
10.5334/jbr-btr.606 |
M |
33 |
60 |
N/A |
VLS and blisters |
10.1016/j.arbres.2012.04.024 |
M |
33 |
N/A |
15 pack/yr |
VLS and blisters |
10.15326/jcopdf.5.1.2017.0180 |
M |
35 |
N/A |
Yes |
Moderate paraseptal emphysema and blisters |
10.1136/thorax.55.4.340 |
M |
35 |
5.7 |
No |
Paraseptal emphysema and blisters |
10.1097/MD.0000000000003232 |
M |
38 |
N/A |
N/A |
Alveolar haemorrhage |
10.1136/thorax.55.4.340 |
M |
44 |
N/A |
Yes |
Blisters |
10.1136/thorax.55.4.340 |
M |
46 |
N/A |
7 pack/yr |
Blisters |
10.7759/cureus.1530 |
M |
47 |
25 |
30 pack/yr |
VLS and blisters |
10.1136/bcr-2014-208064 |
M |
48 |
86 |
25 pack/yr |
Blisters, bronchiectasis and hydroaerial level inside a large bullae |
10.1513/AnnalsATS.201612-974LE |
M |
57 |
N/A |
No |
Alveolar haemorrhage |
Furthermore, tomographic aspects of 8 young individuals (under 30 years) without inclusion criteria for tabagism, respiratory allergy, asthma or chronic obstructive pulmonary disease symptoms were studied. Cannabis load was quantified and their tomographic findings were listed. Another 4 patients older than 30 years were also selected and had their lung parenchyma evaluated (Table 2).
The average age among the 8 young people was 22.7 years (minimum 18, maximum 28, mode and median 25). The average joints-year was 7.2 (1-21.4) and grams consumed per month was 18 (4-30). 5 of the 8 cases had normal tomographic studies. Among the alterations, apex paraseptal emphysema was observed (15.7 joint-year) and discrete air trapping (21.4 and 1 joint-year) (Table 2).
For the 4 older patients, the avarage age was 42 years (minimum 30, maximum 52 and median 37 years). All four agreed to participate in the study as cannabis users, but did not undergo the questionnaire, and it was not possible to assess either their cannabis/tobacco load or their history of respiratory diseases (Table 2). The findings were: air trapping (female, 30 years), apex paraseptal emphysema (male, 45 years), VLS and blisters (male 52 years) and pneumothorax with blisters (male, 44 years).
Table 2. New cases from Hospital Universitário Antônio Pedro and their respective CT findings.
Gender
|
Age
|
Joint-year
|
g/month
|
CT Findings
|
M
|
25
|
1
|
4
|
Mild air trapping
|
F
|
20
|
1,7
|
15
|
Normal
|
M
|
18
|
2
|
20
|
Normal
|
M
|
22
|
2,8
|
30
|
Normal
|
F
|
21
|
6
|
15
|
Normal
|
M
|
25
|
7,14
|
22
|
Normal
|
M
|
28
|
15,7
|
20
|
Foci of paraseptal emphysema at apex
|
M
|
23
|
21,4
|
N/A
|
Mild air trapping
|
F
|
30
|
N/A
|
N/A
|
Air trapping
|
M
|
45
|
N/A
|
N/A
|
Paraseptal emphysema at apex
|
M
|
52
|
N/A
|
N/A
|
VLS e blisters
|
M
|
44
|
N/A
|
N/A
|
Blisters and pneumothorax
|
Images for this section:
Fig. 2: Findings and procedure summary (1/2)
Fig. 3: Findings and Procedure summary (2/2).