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Cannabanoid Hyperemesis Syndrome Causing Pneumomediastinum and Pneumorachis FREE TO VIEW

Shenil Shah, MD; Christopher Gilbert, DO; Jennifer Toth, MD; Michael Reed, MD
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Penn State Milton S. Hershey Medical Center, Hummelstown, PA

Chest. 2014;146(4_MeetingAbstracts):328A. doi:10.1378/chest.1993036
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SESSION TITLE: Miscellaneous Case Report Posters I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Pneumomediastinum is typically secondary to asthma, barotrauma from Valsalva maneuvers, iatrogenic injuries from endoscopy or surgery, or from life-threatening etiologies such as esophageal rupture and tension pneumothorax. Pneumorachis, the presence of intraspinal air, is typically seen after trauma or surgical instrumentation. We present a case of a 31-year-old man with a longstanding history of marijuana abuse who presented with cannabanoid hyperemesis syndrome and was found to have pneumomediastinum and pneumorachis.

CASE PRESENTATION: A 31-year old man experienced 12 days of intractable emesis, nausea, fatigue, and significant thirst. Initial imaging revealed pneumomediastinum and pneumorachis (Figure 1). He was also found to be hypokalemic, hyponatremic, and alkalotic, consistent with his history of hyperemesis. He was treated medically for his symptoms and lab abnormalities and transferred to our facility for concern for esophageal perforation. The patient reported daily marijuana use for years. He experienced a similar episode of hyperemesis a few years prior which resolved after the discontinuation of marijuana use. Recently, he resumed cannabis use, stopping a few days prior to admission. A repeat CT with oral contrast revealed a small contained defect in the distal esophagus. A contrast esophagram the following day showed no extravasation. No surgical intervention was required. His diet was advanced and he was discharged after 72 hours.

DISCUSSION: This novel case illustrates an unusual cause of pneumomediastinum with pneumorachis. Cannabanoid hyperemesis led to esophageal perforation. This syndrome, although rare, is associated with prolonged cannabanoid use and resolves after discontinuation. Unexplained nausea and intractable vomiting in a patient with a history of marijuana use should prompt consideration of this diagnosis. Individuals with significant emesis are at risk for esophageal perforation and metabolic disturbances.

CONCLUSIONS: Cannabanoid use is a rare cause of hyperemesis. When severe, esophageal perforation is a risk.

Reference #1: Sontini, S et al.Cannabanoid hyperemesis syndrome: clinical diagnosis of an underrecognized manifestation of chronic cannabis abuse. World J Gastroenterol 2009;15:1264-6

DISCLOSURE: The following authors have nothing to disclose: Shenil Shah, Christopher Gilbert, Jennifer Toth, Michael Reed

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