Spontaneous pneumomediastinum and ecstasy abuse.

Abstract

Correspondence to: Dr Gareth Quin, Senior Registrar in Accident and Emergency Medicine, Royal Gwent Hospital, Newport NP9 2UB. A 25 year old man attended the accident and emergency department complaining of anterior pleuritic chest pain. Fourteen hours previously he had ingested three ecstasy tablets and danced for several hours. There was no history of trauma or vomiting. Clinical examination suggested pneumomediastinum and this was confirmed on chest radiography (fig 1). The patient was admitted and, in view of the possibility of oesophageal perforation, was kept nil by mouth and started on intravenous fluids and antibiotics. Gastrograffin swallow was normal. He was observed for four days and remained well throughout. After discharge, he experienced no further problems. While the source of our patient's pneumomediastinum remains unclear, the benign clinical course and normal upper gastrointestinal contrast study lessen the likelihood of oesophageal perforation. The temporal association of ecstasy ingestion and subsequent pneumomediastinum, while not proving causation, certainly raises the possibility of a link between the two, especially in view of other case reports. Pittman and Pounsford report a case of pneumomediastinum in a patient who, after ecstasy ingestion, blew a whistle for eight hours.' Levine et al report on a similarly intoxicated patient who developed a pneumomediastinum after an episode of vomiting.2 In the absence of repeated valsalva manoeuvres or vomiting, we conclude that the nature of the physical exertion accompanying ecstasy intoxication led to the causative barotrauma. ----..:.