title: On your toes: Detecting mediastinal air on the chest radiograph in ecstasy abusers.
abstract: Abnormal mediastinal air may be caused by inhalational illicit drug use subsequent to barotrauma resulting from coughing after deep inhalation and breath holding. It may also arise from oesophageal rupture due to retching after ingestion of the illicit drug. The history can alert the practitioner to this cause of chest pain. As chest radiographs are widely accessible and mediastinal air is easily recognisable, the chest radiograph should be included and carefully scrutinised in the diagnostic workup of chest pain in the recreational drug abuser. It is prudent to exclude oesophageal rupture, particularly in the setting of retching, before deciding on conservative and expectant management.
authors.affiliation: Department of Family Medicine, School of Nursing and Public Health, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; KwaZulu-Natal Department of Health, South Africa. naidoom@ukzn.ac.za.
authors.forename: Mergan
authors.initials: M
authors.lastname: Naidoo
authors.forename: Mayuri
authors.initials: M
authors.lastname: Govind
mesh_terms: D001469:Barotrauma / Q000150:complications*; D002637:Chest Pain / Q000209:etiology; D006213:Hallucinogens / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging* / Q000209:etiology*; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000009:adverse effects*; D013902:Radiography, Thoracic; D019966:Substance-Related Disorders / Q000150:complications*; D055815:Young Adult
chemical_list: D006213:Hallucinogens; D018817:N-Methyl-3,4-methylenedioxyamphetamine