Extensive Subcutaneous Emphysema and Pneumomediastinum after Ecstasy Ingestion

Objective. To present a rare case of extensive subcutaneous emphysema and spontaneous pneumomediastinum following ingestion of Ecstasy in a young adult. We also review the relevant literature and discuss how this case supplements it. Case Report. We report a case of a 19-year-old man with a history of painless neck and chest swelling, and no chest pain or breathlessness, after consuming Ecstasy tablets. Radiological imaging showed evidence of pneumomediastinum and extensive subcutaneous emphysema. The patient remained well under observation and his symptoms improved with conservative management. Conclusions. Subcutaneous emphysema and pneumomediastinum after Ecstasy ingestion is uncommon. Cases are often referred to the otolaryngologist as they can present with neck and throat symptoms. Our case showed that the severity of symptoms may not correlate with severity of the anatomical abnormality and that pneumomediastinum should be suspected in Ecstasy users who present with neck swelling despite the absence of chest symptoms. Although all cases reported so far resolved with conservative management, it is important to perform simple investigations to exclude coexisting serious pathology. 1. Introduction The occurrence of subcutaneous emphysema and pneumomediastinum is rare following ingestion of illicit drugs. Ecstasy is a street drug with the active substance 3,4-methylenedioxymethamphetamine (MDMA). It is one of the most commonly used illegal drugs in the UK, with up to two million tablets consumed every week [1]. In this paper, we describe a case of extensive subcutaneous emphysema and spontaneous pneumomediastinum following use of Ecstasy. We also review the relevant literature and discuss how this case supplements it. 2. Case Presentation A 19-year-old otherwise healthy man presented to Accident and Emergency, on his mother’s request, after having awoken four hours earlier with a feeling of “crushed ice” under the skin of his neck, chest, and back. He had no dyspnoea, dysphagia, neck pain, or voice change and had very slight odynophagia. He had drunk heavily the night before and alleged that he had taken 12 Ecstasy tablets during the course of that evening. He denied any history of recent trauma or vigorous physical exertion. He had had no recent episodes of coughing or vomiting. He was on no regular medication, but frequently used street drugs and alcohol. On examination, he was alert, with no obvious respiratory compromise. Blood pressure was 139/73, pulse was 93; respiratory rate was 16 per minute, temperature was normal, and oxygen saturation was