Cannabis ('bong') smoking induced pneumomediastinum and subcutaneous emphysema

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This student vigorously smoked cannabis through a bong, then felt sick and vomited. He subsequently felt crepitus around the chest, shoulder and neck. No chest pain or shortness of breath.

Patient Data

Age: 20
Gender: Male

There is pneumomediastinum. No evidence of a pneumothorax. There is subcutaneous emphysema centred around the right lung apex. The lungs are clear. There is no pleural effusion. The heart size is normal.

Multiplanar imaging immediately following oral contrast. There is extensive pneumomediastinum and subcutaneous emphysema, more so on the right.

Several thin low density bands are seen within the lung parenchyma of the right upper lobe. These extend to the periphery in the right lung apex medially and are in keeping with mild pulmonary interstitial emphysema.

There is no evidence of pulmonary haemorrhage, alveolar consolidation or atelectasis.At the anterior right lung apex, there is an apparent small discontinuity of the pleura with a tiny 1mm wide channel of air seen between lung parenchyma and upper mediastinal gas; this may represent the site of air leak. There is no pneumothorax and no pleural effusion. No bullous or cystic lung disease. No mediastinal fluid or collection is seen.

Conclusion: Extensive pneumomediastinum and subcutaneous emphysema likely due to alveolar rupture or pulmonary interstitial emphysema, both these entities can be related to barotrauma. The leak is suspected in right apex. There are no features to suggest a ruptured oesophagus.

Case Discussion

Alveolar rupture and emphysema are recognized complications of bong smoking. In this case, there is no evidence of "bong lung"

 

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Case information

rID: 29947
Case created: 6th Jul 2014
Last edited: 7th Jan 2016
System: Chest
Inclusion in quiz mode: Included

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