Pneumomediastinum post amphetamine smoking
Smoking amphetamines (ice), now central chest pain. Palpable subcutaneous emphysema.
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Marked subcutaneous emphysema is associated with marked pneumomediastinum, pneumopericardium, small bilateral pneumothoraces and even extradural spinal gas. No apical lung bullae/blebs and no signs of rib/lung trauma.
Gas is presumed to originate from rupture of alveolar sacs into the lung intestitium, thus into the pleural spaces and mediastinum. Reason for rupture might well be high alveolar pressures generated by forced Valvslava manoeuvres (to enhance absorption of the drug) or vomiting as a side effect of the drug(s).
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