Vaping, the use of electronic cigarettes, involves different mechanics than conventional combustion cigarettes. Consumers who vape tend to overinhale and then forcefully exhale to eliminate the vapor, which is usually produced in much greater quantity than generated by a regular cigarette. Effectively, they are performing an exaggerated Valsalva maneuver. This can increase their risk for developing potential spontaneous pneumomediastinum. Here we present a case of spontaneous pneumomediastinum secondary to electronic cigarette use.

Merkel cell carcinoma is a highly aggressive skin neuroendocrine tumor with early malignant potential. Metastasis was previously considered a sign of unresectability and short life expectancy. This report describes an isolated metastasis to the liver from Merkel cell carcinoma of the left frontotemporal area and an effective treatment that may meaningfully prolong life.