MDMA-Induced Pneumomediastinum with an Unusual Presentation

​BY CLAUDIA BORNIA & KHALID MALIK, MDAn 18-year-old healthy man presented to the ED with a sore throat. He said the pain had started a day earlier when he took three capsules of Molly and drank heavily at a music festival.The patient reported pain while swallowing, shortness of breath, and pain in his left rib cage after playing basketball a few days earlier. The patient had no jaw or neck pain, coughing, fever, chills, nausea, vomiting, and diarrhea. He had a blood pressure of 126/76 mm Hg, temperature of 98.2°F (orally), heart rate of 70 bpm, respirations of 18 bpm, and oxygen saturation of 100% on room air. The physical exam demonstrated an alert, awake, and oriented patient with evidence of tenderness in the left rib cage. There were no signs of abdominal tenderness, respiratory distress, or asymmetrical breath sounds. The lungs were clear bilaterally, and the heart sounds were normal.The chest x-ray showed some linear air density streaks in the mediastinum. A CT with and without contrast revealed an extensive pneumomediastinum and considerable subcutaneous emphysema at the base of the neck, posterior right thoracic region, and left axillary area. The results were reviewed with the patient, but he signed out against medical advice after being told of the seriousness of his condition. The patient was advised to return if the condition worsened.CT of pneumomediastinum and subcutaneous emphysema.CT of pneumomediastinum.Methylenedioxymethamphetamine (MDMA) is an amphet...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research