Potential Association of Air Leak Syndromes With E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI)

E-cigarette or vaping product use-associated lung injury (EVALI) has emerged as a public health concern, with most reports describing acute respiratory illness characterized by bilateral infiltrates and hypoxemia. Air leak syndromes, such as spontaneous pneumomediastinum and subcutaneous emphysema, are not yet widely recognized as part of the EVALI spectrum. We present the case of a 15-year-old male with a history of mild asthma who developed extensive subcutaneous emphysema, pneumomediastinum, and pneumorrhachis following the use of vaping products and cannabis inhalation. His presentation included acute respiratory distress, hypoxemia, and swelling of the neck and face. Imaging confirmed widespread air leak without evidence of esophageal perforation. He was managed conservatively with oxygen therapy, total parenteral nutrition, antibiotics, and supportive care. The patient made a full recovery and was discharged with outpatient follow-up. A targeted literature search identified several reports linking vaping to spontaneous air leak syndromes, though most involved young adults. To our knowledge, this represents one of the youngest reported cases, highlighting a potentially underrecognized complication of vaping in adolescents. This case underscores the importance of considering vaping-associated pneumomediastinum in young patients presenting with chest pain and respiratory distress. With vaping prevalence rising sharply among adolescents, clinicians should actively inquire about e-cigarette and cannabis use in such presentations. Further research is needed to clarify the mechanisms, risk factors, and long-term outcomes of vaping-related air leak syndromes.