title: Recreational nitrous oxide inhalation as a rare cause of spontaneous pneumomediastinum.
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.
authors.affiliation: Department of Respiratory Medicine, Barts Health Acute NHS Trust, London, UK.
authors.forename: Rory
authors.initials: R
authors.lastname: McDermott
authors.affiliation: Department of Respiratory Medicine, Lewisham and Greenwich NHS Trust, London, UK.
authors.forename: Karwai
authors.initials: K
authors.lastname: Tsang
authors.affiliation: Department of Medicine, Lewisham and Greenwich NHS Trust, London, UK.
authors.forename: Natasha
authors.initials: N
authors.lastname: Hamilton
authors.affiliation: Department of Respiratory Medicine, Lewisham and Greenwich NHS Trust, London, UK.
authors.forename: Moerida
authors.initials: M
authors.lastname: Belton
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D008478:Mediastinal Emphysema / Q000139:chemically induced*; D009609:Nitrous Oxide / Q000008:administration & dosage / Q000009:adverse effects*; D011026:Pneumopericardium / Q000139:chemically induced*; D011030:Pneumothorax / Q000000981:diagnostic imaging; D013902:Radiography, Thoracic; D013352:Subcutaneous Emphysema / Q000139:chemically induced*; D014057:Tomography, X-Ray Computed
chemical_list: D013287:Illicit Drugs; D009609:Nitrous Oxide