PREVIOUS CASE - DISCUSSION
Adult Male With Neck Discomfort

Robert Hoffman
New York City Poison Center
New York, NY

Int J Med Toxicol 1998; 1(4): 20


These case conferences are supported by a grant from Orphan Medical, Inc.

See also NEW CASE - SUMMARY  - 1998; 1(4): 17

Pneumothorax, pneumomediastinum, pneumopericardium, and pneumoperitoneum all occur following substance abuse. While most recent reports are attributed to smoking crack cocaine, insufflation of cocaine or heroin, smoking marijuana, and inhaling nitrous oxide have all been associated with these findings. Because of the diverse nature of the toxins involved, it must be concluded that the development of a "pneumo" is not a manifestation of direct drug toxicity, but rather of barotrauma resulting from direct use of a high pressure cylinder (nitrous oxide), prolonged Valsalva maneuvers, or an attempt to inflate the lungs beyond their capacity.

Patients typically present with neck, chest, or abdominal pain, or difficulty swallowing, but are also occasionally asymptomatic only to be discovered by routine radiographic studies. As seen in the AP chest radiograph presented here, there is a prominence of air in the soft tissues of the neck and chest. The CT scan demonstrates air in the mediastinum (best seen posterior to the heart).

Treatment varies with location of the air leak and size. It is important to remember that these events commonly occur as manifestations of trauma, which is often occult in substance abusers so that a thorough history and physical examination is usually required. Pneumoperitoneum is usually evaluated surgically, while pneumomediastinum and pneumopericardium are typically observed. Small pneumothoraces can be observed, while large ones are treated with needle aspiration or chest tube. This patient was followed over several weeks with complete resolution of radiographic findings.

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Int J Med Toxicol 1998; 1(4): 20

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