Pneumomediastinum, pneumothorax, and subcutaneous emphysema after alternate cocaine inhalation and marijuana smoking

Luque, Maximo A.; Cavallaro, Daniel L.; Torres, Margarita; Emmanual, Patricia; Hillman, James V.

doi:10.1097/00006565-198706000-00012

Cited by 61 publications

(30 citation statements)

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“…[7][8][9] Barotrauma, including pneumothorax, pneumomediastinum, and pneumorachis attributable to repeated forceful inhalations, physiologically similar to a Müller maneuver, have been described as complications of marijuana smoking and other inhalational drug use. [10][11][12][13][14] In our case the aggressive use of incentive spirometry, coupled with underlying emphysema and hyperinflation, was a likely explanatory factor in the development of barotrauma and the pneumothorax.…”

Section: Discussionmentioning

confidence: 55%

Pneumothorax Caused by Aggressive Use of an Incentive Spirometer in a Patient With Emphysema

Kenny

Kuschner

2012

Respir Care

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A 68-year-old man presented to the emergency department with a small pneumothorax following aggressive use of an incentive spirometer. The patient had a baseline chest radiograph consistent with emphysema. He was initially treated with oxygen in the emergency department, with resolution of his symptoms. The pneumothorax resolved spontaneously over a period of 3 days. The development of the pneumothorax was likely due to the patient's repeated forceful inspiratory maneuvers in the setting of emphysema and lung hyperinflation. Inspiratory resistive breathing can cause large negative swings in intrathoracic pressure, which may result in mechanical stress of lung tissue. This is the first report of a secondary pneumothorax associated with use of an incentive spirometer. Patients with bullous emphysema should be counseled to avoid frequent high intensity maneuvers with an incentive spirometer if the potential benefits of the procedure are marginal.

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Section: Discussionmentioning

confidence: 55%

Pneumothorax Caused by Aggressive Use of an Incentive Spirometer in a Patient With Emphysema

Kenny

Kuschner

2012

Respir Care

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“…A number of cases of spontaneous pneumothorax and/or pneumomediatinum associated with marijuana smoking have been reported [60][61][62][63][64][65][66][67]. The mechanism of this association is believed to be due to the repeated performance of prolonged Valsalva maneuvers during breathholding following deep inhalation of the smoke.…”

Section: Pulmonary Barotrauma and Bullous Lung Diseasementioning

confidence: 99%

Smoked Marijuana as a Cause of Lung Injury

Tashkin

2005

Monaldi Arch Chest Dis

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P. Tashkin. In many societies, marijuana is the second most commonly smoked substance after tobacco. While Δ9-tetrahydrocannabinol (THC) is unique to marijuana and nicotine to tobacco, the smoke of marijuana, like that of tobacco, consists of a toxic mixture of gases and particulates, many of which are known to be harmful to the lung. Although far fewer marijuana than tobacco cigarettes are generally smoked on a daily basis, the pulmonary consequences of marijuana smoking may be magnified by the greater deposition of smoke particulates in the lung due to the differing manner in which marijuana is smoked. Whereas THC causes modest short-term bronchodilation, regular marijuana smoking produces a number of long-term pulmonary consequences, including chronic cough and sputum, histopathologic evidence of widespread airway inflammation and injury and immunohistochemical evidence of dysregulated growth of respiratory epithelial cells, that may be precursors to lung cancer. The THC in marijuana could contribute to some of these injurious changes through its ability to augment oxidative stress, cause mitochondrial dysfunction, and inhibit apoptosis. On the other hand, physiologic, clinical or epidemiologic evidence that marijuana smoking may lead to chronic obstructive pulmonary disease or respiratory cancer is limited and inconsistent. Habitual use of marijuana is also associated with abnormalities in the structure and function of alveolar macrophages, including impairment in microbial phagocytosis and killing that is associated with defective production of immunostimulatory cytokines and nitric oxide, thereby potentially predisposing to pulmonary infection. In view of the growing interest in medicinal marijuana, further epidemiologic studies are needed to clarify the true risks of regular marijuana smoking on respiratory health.

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“…8,36,57 Review of the health records and the history should focus on identifying a predisposing or a triggering factor (including inhalation of drugs in adolescents, which often involves a Valsalva maneuver). 18,36,40,41,43,58 The physical examination should assess the extension of subcutaneous emphysema and search for the classical Hamman sign, which is almost pathognomonic 59 and consists of precordial systolic crepitation, sometimes associated with a reduction in heart sounds. 60 Evidence for asthma or other underlying causes should also be searched for.…”

Section: Clinical Diagnosismentioning

confidence: 99%