Vanishing lung syndrome (VLS) is a rare and distinct clinical syndrome that 
usually affects young men. VLS leads to severe progressive dyspnea and is 
characterized by extensive, asymmetric, peripheral, and predominantly upper lobe 
giant lung bullae. Case reports have suggested an additive role of marijuana use 
in the development of this disease in young male tobacco smokers. We herein 
report a case of a 65-year-old Hispanic male previously diagnosed with severe 
emphysema and acquired immune deficiency syndrome (AIDS), with a history of 
intravenous heroin use and active marijuana smoking who presents to the 
emergency department with severe progressive shortness of breath he was found to 
have multiple large subpleural bullae occupying more than one-third of the 
hemithorax on chest computerized tomography (CT), characteristic of vanishing 
lung syndrome. The patient was mechanically ventilated and later developed a 
pneumothorax requiring chest tube placement and referral for surgical 
bullectomy. Surgical bullectomy has shown high success rates in alleviating the 
debilitating symptoms and preventing the life threatening complications of this 
rare syndrome. This case further emphasizes the importance of recognizing VLS in 
patients with severe emphysema and heavy marijuana smoking.