Chest pain in a young girl

Abstract

A 28-year-old previously healthy woman presented with left-sided pleuritic chest pain of 18 hours duration. The pain started suddenly in the early hours of the morning while she was at a night club. Initially the pain was dull but several hours later it became more severe and was made worse by deep inspiration. Four hours before the pain started she had taken one 'Ecstasy' (methylenedioxymethamphetamine) and one 'Speed' (methylamphetamine hydrochloride) tablet. There was no history of trauma or asthma and she did not complain of any cough, sputum or haemoptysis. She was on the oral contraceptive pill and never smoked.On examination she was apyrexial and rather anxious. Her pulse rate was 82 beats/min and blood pressure was 1 16/80 mmHg. Auscultation of the heart revealed a crunching systolic sound and the chest was clear. Examination of the neck revealed surgical emphysema.Full blood count, erythrocyte sedimentation rate, blood chemistry, arterial blood gases, electrocardiogram and a water-soluble contrast swallow were all normal. The chest X-rays are shown below (figures 1 and 2).The patient was given analgesia and she was closely monitored. The chest pain subsided after four days when she was discharged home. A repeat chest X-ray was performed at two and four weeks.

Spontaneous pneumomediastinum, pneumothorax and ecstasy abuse

“…While obtaining an accurate history from patients with recent drug use can be difficult, in this case there was no reported episode of asthma, vomiting, trauma or Valsalva. This is similar to previous reported cases of spontaneous pneumomediastinum in the setting of ecstasy use 6,9,11,12 . This association between ecstasy and barotrauma may result from the decrease in interstitial pressure and hence increased bronchovascular gradient occurring with the high levels of physical exertion undertaken by some ecstasy users.…”

“…Spontaneous pneumomediastinum and pneumothorax associated with recreational drug use are known to occur 5–13 (Table 1). The majority of cases are thought to be due to barotrauma, related to the technique of ingestion.…”

“…Pneumothorax following ‘pocket shots’ (attempted intravenous injection into the internal jugular vein) and attempted subclavian vein injection have been described 14 . Spontaneous pneumomediastinum has been reported in association with ecstasy use, 6–8,10–12 but pneumothorax in association with ecstasy use has been reported only once previously, associated with 8 h of vigorous whistle blowing 7 …”

“…Spontaneous pneumomediastinum in the setting of recreational drug use is usually a benign condition and the patients are clinically stable 6,7,9–13 . Management is supportive and most can be managed as outpatients with simple analgesia.…”

“…[7][8][9] If the mediastinal pressure rises abruptly pneumothorax may also occur. 5 Spontaneous pneumomediastinum and pneumothorax associated with recreational drug use are known to occur [5][6][7][8][9][10][11][12][13] ( Table 1). The majority of cases are thought to be due to barotrauma, related to the technique of ingestion.…”