Disorders of the Pleura |

Getting Higher Than the Empire State: Pneumomediastinum and Bilateral Pneumothorax Associated With Smoking Synthetic Cannabinoid FREE TO VIEW

Mustafa Calik, MD; Saniye Calik, MD; Can Gokay Yildiz, MD
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Konya Education and Research Hospital, Konya, Turkey

Chest. 2015;148(4_MeetingAbstracts):431A. doi:10.1378/chest.2278116
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SESSION TITLE: Disorders of the Pleura Global Case Reports

SESSION TYPE: Global Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Pneumomediastinum and pneumothorax known as free air in the mediastinum and pleural space respectively, is an uncommon complication of Phytocannabinoids known as marijuana [1]. Although it has been used for recreation and medicinal purposes for centuries, synthetic cannabinoids (SCs) have just emerged in recent years. SCs are functionally, but not structurally, similar to Δ9 tetrahydrocannabinol (THC) which is responsible for psychoactive effects such as heightened mood or euphoria and relaxation [2]. Herein, we represent a patient with pneumomediastinum and bilateral pneumothorax occurring after the use of SC.

CASE PRESENTATION: A 13-year-old boy patient was brought to the emergency department with sudden onset of chest pain, dyspnoea and fainting. An emergency oral intubation was performed and referred to ICU. The thoracic CT scan that was performed after ICU admissions revealed bilateral pneumothorax, pneumomediastinum and subcutaneous emphysema. A right tube thoracostomy was performed. No tube drainage was necessary for the left hemithorax. Air collections resolved spontaneously within days. The patient was discharged on the thirteenth day of admission without complication.

DISCUSSION: The popularity and usages of SCs are increasing exponentially due to the more powerful and longer effect, easy access, affordability, perception that these products are legal and herbal, and the undetectability in routine drug tests. SCs produce physiological and psychoactive effects similar to THC, but with greater intensity, resulting in medical and psychiatric emergencies [3].

CONCLUSIONS: SCs can cause severe and life-threatening symptoms as in our case. This case is of importance because it shows for the first time pneumomediastinum and bilateral pneumothorax secondary to the use of SCs.

Reference #1: Tashkin DP. Effects of marijuana smoking on the lung. Ann Am Thorac Soc. 2013 Jun;10(3):239-47

Reference #2: Castaneto MS, Gorelick DA, Desrosiers NA, Hartman RL, Pirard S, Huestis MA. Synthetic cannabinoids: epidemiology, pharmacodynamics, and clinical implications. Drug Alcohol Depend. 2014 Nov 1;144:12-41.

Reference #3: Spaderna M, Addy PH, D'Souza DC. Spicing things up: synthetic cannabinoids. Psychopharmacology (Berl). 2013 Aug;228(4):525-40.

DISCLOSURE: The following authors have nothing to disclose: Mustafa Calik, Saniye Calik, Can Gokay Yildiz

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