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Barzallo TP, Marchan CA, Salgado OJ, Espinosa HM. Spontaneous Pneumomediastinum in a 15-Year-Old Adolescent After Unintended Overexposure to Paint Diluent (Thinner) Fumes: First Reported Case. THERAPEUTIC ADVANCES IN PULMONARY AND CRITICAL CARE MEDICINE 2023; 18:11795484231201751. [PMID: 37822328 PMCID: PMC10564079 DOI: 10.1177/11795484231201751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/02/2023] [Indexed: 10/13/2023]
Abstract
Spontaneous pneumomediastinum (SPM) is the presence of air in the mediastinal interstices in the absence of any surgical or medical procedure, chest trauma, or mechanical ventilation. SPM can occur during vigorous Valsalva maneuvers, such as weight lifting, coughing fits, hyperemesis gravidarum, and so on, or during inhalation of illicit substances or toxic agents, as a result of an abrupt increase in pressure in the tracheal tree. Preexisting underlying lung disease may be a contributing factor. In the present case, we report for the first time an SPM due to accidental overexposure to paint thinner in a 15-year-old male from a low-income rural family. He was offered a job painting the inside of a house, which he accepted to earn some money for the family household. However, due to his inexperience, he overdosed on a can of paint with thinner. About 2 h after starting work, he began to feel increasingly severe chest pain and had to be rushed to the local level one basic hospital by his parents. Physical examination revealed subcutaneous emphysema over the supraclavicular area and crackles in the precordial area. Chest radiographs showed a pneumomediastinum. In retrospect, the patient denied coughing or sneezing attacks after exposure. He was transferred to a regional tertiary hospital for further diagnostic evaluation to rule out airway/esophageal perforation. Chest computed tomography confirmed underlying SPM and subcutaneous emphysema. The oesophagogram and bronchoscopy were unremarkable. SPM, possibly secondary to overexposure to thinner vapors, a hydrocarbon-based compound, was the final diagnosis. The patient was discharged asymptomatic on day 5.
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Affiliation(s)
- Tania P Barzallo
- School of Medicine, Universidad Católica de Cuenca (UCACUE), Cuenca, Ecuador
- Formerly: Department of Pediatrics, Hospital Vicente Corral Moscoso, Cuenca, Ecuador
| | - Claudia A Marchan
- School of Medicine, Universidad Católica de Cuenca (UCACUE), Cuenca, Ecuador
| | - Octavio J Salgado
- Department of Medical Research, School of Medicine, Universidad Católica de Cuenca (UCACUE), Cuenca, Ecuador
| | - Hermel M Espinosa
- Department of Medical Research, School of Medicine, Universidad Católica de Cuenca (UCACUE), Cuenca, Ecuador
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Paul M, Paul P, Dey D, Bhardwaj A, Paul K. A Case of Spontaneous Pneumomediastinum Following Ecstasy and Marijuana Use. Cureus 2021; 13:e15871. [PMID: 34327096 PMCID: PMC8302393 DOI: 10.7759/cureus.15871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 11/08/2022] Open
Abstract
Spontaneous pneumomediastinum (SPM) is a benign and self-limiting condition more commonly seen in young adults. Radiology imaging of the chest, including X-ray or CT scan, is the gold standard for diagnosis. Ecstasy, also known as 3,4-methylenedioxymethamphetamine (MDMA) is a synthetic amphetamine derivative widely abused for an increased sense of well-being and euphoria. Marijuana is also abused for recreational purposes. SPM has been reported after both Ecstasy and marijuana use. SPM after these illicit drugs abuse usually has a benign and self-limiting course with supportive management. However, it is always important to rule out serious associated conditions like esophageal perforation. Here, we present a 22-year-old male who developed SPM after Ecstasy ingestion and marijuana inhalation.
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Affiliation(s)
- Mishouri Paul
- Medicine, Interfaith Medical Center, New York City, USA
| | - Prodip Paul
- Internal Medicine, Geisinger Community Medical Center, Scranton, USA
| | - Dipon Dey
- Epidemiology and Public Health, ZWH Medical Care PC, Queens, USA
| | - Amit Bhardwaj
- Internal Medicine, Geisinger Community Medical Center, Scranton, USA
| | - Koushik Paul
- Clinical Pathology, Community Based Medical College Hospital, Mymensingh, BGD
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3
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Spontaneous Pneumomediastinum and Subcutaneous Emphysema following Cocaine Inhalation and Ecstasy Ingestion. Case Rep Otolaryngol 2019; 2019:6972731. [PMID: 30918737 PMCID: PMC6409058 DOI: 10.1155/2019/6972731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/16/2019] [Accepted: 02/04/2019] [Indexed: 11/18/2022] Open
Abstract
Spontaneous pneumomediastinum (SPM) and subcutaneous emphysema are rare complications of illicit drug abuse. Thorough history, examination, and investigations are required to rule out fatal complications such as oesophageal perforation. We present a case of a 21-year-old male presenting with pleuritic chest pain one day after cocaine inhalation and ingesting ecstasy. Conservative supportive management is appropriate when this occurs spontaneously without radiological evidence of visceral perforation.
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Obiechina NE, Jayakumar A, Khan Y, Bass J. Bilateral pneumothorax, surgical emphysema and pneumomediastinum in a young male patient following MDMA intake. BMJ Case Rep 2018; 2018:bcr-2017-223103. [PMID: 29627778 DOI: 10.1136/bcr-2017-223103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
MDMA (3,4-methylenedioxymethamphetamine) or 'Ecstasy' is an illicit drug frequently used by young people at parties and 'raves'. It is readily available in spite of the fact that it is illegal.1 It is perceived by a lot of young people as being 'harmless', but there have been a few high-profile deaths associated with its use.2 Known side effects of MDMA include hyperthermia, rhabdomyolysis, coagulopathy and cardiac arrhythmias.3 Rarer side effects include surgical emphysema and pneumomediastinum, which have been better described with cocaine abuse.4-6 We present a case of bilateral pneumothorax, surgical emphysema and pneumomediastinum in a young man after taking ecstasy.
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Affiliation(s)
| | - Ahrane Jayakumar
- Elderly Medicine, Burton Hospitals NHS Foundation Trust, Burton on Trent, UK
| | - Yusra Khan
- Burton Hospitals NHS Foundation Trust, Burton on Trent, UK
| | - James Bass
- Burton Hospitals NHS Foundation Trust, Burton on Trent, UK
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5
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Van den Kerckhove E, Roosens L, Siozopoulou V, Verbrugghe W, Aerts J, Huyskens J, Raemen H, Jorens PG. Airway Necrosis and Barotrauma after Ecstasy Inhalation. Am J Respir Crit Care Med 2017; 196:105-106. [PMID: 28288287 DOI: 10.1164/rccm.201612-2416im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Hannelore Raemen
- 6 Department of Emergency Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
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Wong OF, Kwan GWM, Tsang PHK, Lee HM, Yip KH. Pneumomediastinum, Surgical Emphysema and Pneumorrhachis after Insufflation of Ketamine. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We report a rare complication after ketamine abuse. A 26-year-old known ketamine abuser developed pneumomediastinum, extensive surgical emphysema and pneumorrhachis after ‘snorting’ ketamine. He also suffered from acute on chronic renal failure and liver function impairment due to ketamine use. His pneumomediastinum and subcutaneous emphysema resolved with conservative management. Pneumomediastinum is a well-reported complication after illicit drug use, particularly smoking ‘crack’ cocaine. This case illustrates that such complication may also occur in ketamine abuse.
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7
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Pneumomediastinum Secondary to Barotrauma after Recreational Nitrous Oxide Inhalation. Case Rep Gastrointest Med 2016; 2016:4318015. [PMID: 27957356 PMCID: PMC5124453 DOI: 10.1155/2016/4318015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/03/2016] [Accepted: 10/18/2016] [Indexed: 11/17/2022] Open
Abstract
We present a case of a seventeen-year-old patient, admitted in the care of the surgical team following inhalation of nitrous oxide at high pressure, leading to extensive pneumomediastinum and surgical emphysema. We discuss the subsequent investigations and management for this patient. In the absence of history of airway injury and respiratory problems including asthma and with no oesophageal perforation on investigations, the diagnostic and management challenges encountered have been discussed which will help in future management of similar cases.
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Chousein EGU, İliaz S, Nizam M, Öztürk S, Çağlar E. Spontaneous Mediastinal Emphysema Associated with the Use of Synthetic Cannabinoid (Bonsai). Turk Thorac J 2016; 17:38-40. [PMID: 29404121 DOI: 10.5578/ttj.17.1.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/17/2015] [Indexed: 11/15/2022]
Abstract
Spontaneous Mediastinal Emphysema (SME), which is a rarely seen case is defined as the detection of free air in the mediastinum without any trauma. Although rare, some cases secondary to drug use have been reported. In this study, two SME cases that developed due to the use of a synthetic cannabinoid known as "bonzai", which has recently become widespread in Turkey, are presented. We would like to emphasize that SME should also be considered in the differential diagnosis of patients who present with the symptoms of chest pain and dyspnea and have a history of drug use.
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Affiliation(s)
- Efsun Gonca Uğur Chousein
- Clinic of Chest Surgery, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey
| | - Sinem İliaz
- Clinic of Chest Surgery, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey
| | - Merve Nizam
- Clinic of Chest Surgery, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey
| | - Sakine Öztürk
- Clinic of Chest Surgery, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey
| | - Emel Çağlar
- Clinic of Chest Surgery, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey
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McDermott R, Tsang K, Hamilton N, Belton M. Recreational nitrous oxide inhalation as a rare cause of spontaneous pneumomediastinum. BMJ Case Rep 2015; 2015:bcr-2015-209750. [PMID: 26392441 DOI: 10.1136/bcr-2015-209750] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 17-year-old girl presented to the A&E department with significant neck swelling with associated chest, neck and throat pain. She reported recreational inhalation of nitrous oxide and ingestion of MDMA (3,4-methylenedioxy-methamphetamine) in the preceding hours. There was no history of trauma or vomiting. Clinical examination revealed extensive subcutaneous emphysema. There was no airway compromise. A chest X-ray suggested the presence of a pneumomediastinum. Subsequent CT of the thorax confirmed an anterior pneumothorax and a pneumopericardium. The patient was admitted for observation and intravenous antibiotics. Further investigations ruled out an oesophageal perforation. The patient was discharged following a period of clinical stability and has since made an uneventful recovery. MDMA ingestion has been cited as a rare cause of spontaneous pneumomediastinum in a series of case reports. In this case, it is likely that the inhalation of nitrous oxide contributed to the development and expansion of a pneumomediastinum.
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Affiliation(s)
- Rory McDermott
- Department of Respiratory Medicine, Barts Health Acute NHS Trust, London, UK
| | - Karwai Tsang
- Department of Respiratory Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Natasha Hamilton
- Department of Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Moerida Belton
- Department of Respiratory Medicine, Lewisham and Greenwich NHS Trust, London, UK
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Allen CJ, Teisch LF, Stahl KD. Spontaneous pneumomediastinum, pneumopericardium and epidural pneumatosis: insights on clinical management. ACTA ACUST UNITED AC 2015; 17:20-3. [PMID: 25738399 DOI: 10.3109/17482941.2015.1005103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Spontaneous pneumomediastinum is a benign condition that has been reported, however the association with epidural pneumatosis is much less common. A 27-year-old male presented with concomitant air in the epidural space, mediastinum and pericardium after illicit drug use and engagement in sexual activity. The patient was hemodynamically stable. Non-invasive tests ruled out aerodigestive injury. The patient was discharged after a short observation without intervention. Invasive and potentially risky diagnostic tests may be safely avoided in patients who remain asymptomatic with this unique presentation.
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Affiliation(s)
- Casey J Allen
- Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center . Miami, Florida , USA
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11
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Abstract
Illicit stimulants, such as cocaine, amphetamine, and their derivatives (e.g., "ecstasy"), continue to exact heavy toll on health care in both developed and developing countries. The US Department of Health and Human Service reported over one million illicit drug-related emergency department visits in 2010, which was higher than any of the six previous years. Both inhaled and intravenous forms of these substances of abuse can result in a variety of acute and chronic injuries to practically every part of the respiratory tract, leading potentially to permanent morbidities as well as fatal consequences--including but not limited to nasal septum perforation, pulmonary hypertension, pneumothorax, pneumomediastinum, interstitial lung disease, alveolar hemorrhage, reactive airway disease, pulmonary edema, pulmonary granulomatosis, infections, foreign body aspiration, infections, bronchoconstriction, and thermal injuries. Stimulants are all rapidly absorbed substances that can also significantly alter the patient's systemic acid-base balance and central nervous system, thereby leading to further respiratory compromise. Mounting evidence in the past decade has demonstrated that adulterants coinhaled with these substances (e.g., levamisole) and the metabolites of these substances (e.g., cocaethylene) are associated with specific forms of systemic and respiratory complications as well. Recent studies have also demonstrated the effects of stimulants on autoimmune-mediated injuries of the respiratory tract, such as cocaine-induced midline destructive lesions. A persistent challenge to studies involving stimulant-associated respiratory toxidromes is the high prevalence of concomitant usage of various substances by drug abusers, including tobacco smoking. Now more than ever, health care providers must be familiar with the multitude of respiratory toxidromes as well as the diverse pathophysiology related to commonly abused stimulants to provide timely diagnosis and effective treatment.
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Clause AL, Coche E, Hantson P, Jacquet LM. Spontaneous pneumomediastinum and epidural pneumatosis after oral ecstasy consumption. Acta Clin Belg 2014; 69:146-8. [PMID: 24724761 DOI: 10.1179/0001551213z.00000000019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A 19-year-old man was admitted with acute dyspnoea. Physical examination revealed subcutaneous emphysema in the cervical and thoracic area. This was further confirmed by the total body computed tomography that also demonstrated mediastinal emphysema. Epidural pneumatosis of the thoracis spine was also evident. There was no history of trauma, but well of a recent oral ecstasy consumption during a techno rave party, associated with intense dancing and jumping. Clinical course was favourable with conservative therapy.
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13
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Graham R, Bowen N, Singh J. Mephedrone inhalation causes pneumomediastinum. BMJ Case Rep 2014; 2014:bcr-2014-203704. [PMID: 24614784 DOI: 10.1136/bcr-2014-203704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 17-year-old male patient presented to A&E with swelling on the right side of his neck, extending to below the clavicle, associated with neck pain and dysphonia. On examination, subcutaneous supraclavicular and chest wall emphysema was noted. Clinical observations and bloods were normal. A chest X-ray and subsequent CT of the thorax showed evidence of pneumomediastinum and subcutaneous emphysema. The patient denied any history of trauma but admitted to inhalation of mephedrone 3 days previously. The patient was discussed with the regional cardiothoracic unit who advised conservative management. He was treated prophylactically with antibiotics and was initially kept nil by mouth, but diet was introduced 24 h later. He remained well, his dysphonia resolved and his subcutaneous emphysema improved. He was discharged after 3 days. He has not attended any formal follow-up but was well when contacted by phone.
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Affiliation(s)
- Ruth Graham
- Department of General Surgery, West Wales General Hospital, Carmarthen, UK
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Dajer-Fadel WL, Argüero-Sánchez R, Ibarra-Pérez C, Navarro-Reynoso FP. Systematic review of spontaneous pneumomediastinum: a survey of 22 years' data. Asian Cardiovasc Thorac Ann 2013; 22:997-1002. [PMID: 24887879 DOI: 10.1177/0218492313504091] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe and clarify management protocols in relation to spontaneous pneumomediastinum, and try to integrate criteria on this subject. BACKGROUND Thoracic physicians are faced with patients who present with gas in the mediastinum, frequently without an obvious etiologic factor. Published material contains heterogeneous information from which different conclusions can be drawn. METHODS In a Medline search from 1990 to 2012, we collected data on mortality, morbidity, signs, symptoms, etiologic factors, and diagnostic methods. Standardized mean differences were calculated. RESULTS We identified 600 patients in 27 papers with series of >5 patients without precipitating or etiologic factors previous to the clinical presentation, but athletic activity, drug abuse, and history of asthma played an apparent role in the disease process. Most patients complained of thoracic pain and dyspnea, with subcutaneous emphysema and Hamman's sign. The most common complication was tension pneumothorax. Morbidity was seen in 2.8%; no mortality has been reported so far. CONCLUSION Spontaneous pneumomediastinum is a rare disease with a benign course, which should be treated conservatively unless a complication mandates an invasive procedure. An algorithm for diagnosis and treatment is offered, based on the available evidence.
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Affiliation(s)
- Walid L Dajer-Fadel
- Department of Cardiothoracic Surgery, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Rubén Argüero-Sánchez
- Department of Cardiothoracic Surgery, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Carlos Ibarra-Pérez
- Department of Cardiothoracic Surgery, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico
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Extensive subcutaneous emphysema and pneumomediastinum after ecstasy ingestion. Case Rep Otolaryngol 2013; 2013:795867. [PMID: 24187639 PMCID: PMC3800631 DOI: 10.1155/2013/795867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 08/30/2013] [Indexed: 11/23/2022] Open
Abstract
Objective. To present a rare case of extensive subcutaneous emphysema and spontaneous pneumomediastinum following ingestion of Ecstasy in a young adult. We also review the relevant literature and discuss how this case supplements it. Case Report. We report a case of a 19-year-old man with a history of painless neck and chest swelling, and no chest pain or breathlessness, after consuming Ecstasy tablets. Radiological imaging showed evidence of pneumomediastinum and extensive subcutaneous emphysema. The patient remained well under observation and his symptoms improved with conservative management. Conclusions. Subcutaneous emphysema and pneumomediastinum after Ecstasy ingestion is uncommon. Cases are often referred to the otolaryngologist as they can present with neck and throat symptoms. Our case showed that the severity of symptoms may not correlate with severity of the anatomical abnormality and that pneumomediastinum should be suspected in Ecstasy users who present with neck swelling despite the absence of chest symptoms. Although all cases reported so far resolved with conservative management, it is important to perform simple investigations to exclude coexisting serious pathology.
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Lam PK, Wong TW, Lau CC. Pneumomediastinum after Smoking Cocaine: A Case Report and Review of Literature. HONG KONG J EMERG ME 2011. [DOI: 10.1177/102490791101800105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cocaine abuse has become more affordable and popular amongst drug abusers locally in recent years. Spontaneous pneumomediastinum is an uncommon but a well-reported complication after smoking “crack” cocaine in the West. We report a case of spontaneous pneumomediastinum after smoking cocaine. The patient was managed conservatively and he recovered uneventfully. A review of literature on the mechanism, clinical presentation and management is presented.
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Figueiredo S, Fernandes G, Morais A. [Bullous emphysema associated with drug abuse]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010; 16:157-61. [PMID: 20054515 DOI: 10.1016/s0873-2159(15)30013-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Bullous emphysema is characterized by permanent enlargement of airspaces distal to the terminal bronchiole accompanied by destruction of alveolar walls. Several aetiologies have been described, namely deficiency of alpha1 -antitrypsin and the consumption of tobacco. With the exception of the deficiency of alpha1 -antitrypsin, some cases of bullous emphysema in the young adult continue without known aetiology. Some cases of bullous emphysema have been described, emphasising the relationship between the disease and drug consumption. The association possibly creates the conditions for the development of large lung bullae, with particular exuberance for the superior lobes. The authors describe two clinical cases of young patients, with history of consumption of smoked substance abuse and bullous emphysema.
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18
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Bravo R. Tired from mowing the lawn. J Pediatr Health Care 2010; 24:123-6. [PMID: 20189065 DOI: 10.1016/j.pedhc.2009.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 09/22/2009] [Accepted: 09/28/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Rosalynn Bravo
- Pulmonary Clinic Nurse Practitioner, Connecticut Children's Medical Center Pulmonary Clinic, Hartford, CT, USA.
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Irvine DF, Crone W. Sudden onset of substernal chest pain in a college student at rest. JAAPA 2009; 22:26, 31-2. [DOI: 10.1097/01720610-200906000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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[A young man' spontaneous pneumomediastinum]. ACTA ACUST UNITED AC 2009; 28:505-6. [PMID: 19427160 DOI: 10.1016/j.annfar.2009.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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