X-ray Quiz: a Young Man with Chest Pain

Abstract

A 21-year-old man presented to the emergency department complaining of ill-defined anterior chest wall pain and discomfort for two days, after a drinking spree. The pain was aggravated by deep breathing. There was no history of recent trauma. There was no other symptom. He was healthy all along. His blood pressure was 123/60 mmHg, pulse rate 95 beats/ minute, respiratory rate 16 breaths/minute and oral temperature 36.4°C. The physical examination was essentially normal. There was no local tenderness of the chest wall. Chest X-ray was taken (Figure 1).

Pneumomediastinum after Smoking Cocaine: A Case Report and Review of Literature

“…Pneumomediastinum reported after ecstasy abuse is presumably the result of over-exertion and extreme physical activity over a prolonged period of time. [16][17][18] The clinical presentation of cocaine associated pneumomediastinum should be more or less the same as that of spontaneous pneumomediastinum in general, as supported by various case reports and a case series of 47 patients in which 55% of cases were precipitated by occasional use of cocaine. 12 According to many large case series of spontaneous pneumomediastinum, acuteonset chest pain was found to be the predominant symptom.…”

Pneumopericardium, pneumomediastinum and surgical emphysema in spontaneous pneumothorax

“…5 The incidence is low at 1 in 30 000 hospital admissions. 6 It is sometimes associated with conditions leading to increased intrathoracic pressure such as asthma, severe coughing, Valsalva manoeuvre, 7 diabetic ketoacidosis, vomiting, childbirth and inhalational drug abuse. 8 In these instances, it is thought that excessive intra-alveolar pressures lead to rupture of perivascular alveoli.…”

“…Breathing of 100% oxygen will enhance reabsorption of free air by increasing the gradient of nitrogen between alveoli and tissue. 6 Epidural pneumatosis occurring through seepage of air along the nerve sheaths can cause radiculopathy and paraplegia; hence, follow-up of this rarely seen entity is important.…”

Spontaneous Pneumomediastinum: An Uncommon Complication from an Augmented Physiological Belching (Imitating a TV Show Game)

“…Spontaneous pneumomediastinum has been reported to be associated with many different clinical conditions such as asthma, 2 diabetic ketoacidosis, 3 childbirth, 4 forceful straining during exercise, 5 inhalation of drug, 1 ecstasy ingestion 6 and any other activities associated with the Valsalva manoeuver. 1 Furthermore, spontaneous pneumomediastinum was associated with voluntary Valsalva manoeuver after self-induced oral injury.…”