EP-68 A Case of Spontaneous Pneumomediastinum due to Marijuana usage- A rare cause

Abstract

Abstract Pneumomediastinum without trauma or clear secondary cause is called Spontaneous pneumomediastinum with an incidence between 0.001%-0.014% and most commonly seen in young males. Marijuana smoking has rarely been identified as a possible cause of spontaneous pneumomediastinum, which is likely caused by barotrauma during breathing manoeuvres. Fewer than 10 case reports have been reported in the literature on Marijuana causing Spontaneous pneumomediastinum. We present a 24year male who presented with dysphagia, swelling and crackling under the skin of his neck for the past 12hours, half an hour after blowing his nose. There was no chest pain or dyspnoea, and he was hemodynamically stable with normal blood investigations. He smokes cannabis regularly and occasionally does cocaine. On examination, surgical emphysema was felt on both sides of the neck; the systemic examination was unremarkable. CT thorax demonstrated extensive pneumomediastinum and surgical emphysema from the angle of the jaw throughout the neck and down to the right subcapsular region. No pneumothorax was seen, and lung parenchyma was unremarkable. However, to rule out the clinical suspicion of oesophageal rupture, he had a CT oesophagus with oral contrast, which showed no extravasation of contrast from the oesophagus. The patient was admitted for observation, and the Chest X-ray after 12hours dint show pneumothorax. He was clinically well, tolerating oral feeds, so he was discharged with oral antibiotics as a prophylactic cover as per UGI surgeons. The knowledge about this rare cause would help the physicians diagnose and educate the patients on the risk involved in using Marijuana.