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Training Level

Resident PGY 1


Henry Ford Hospital


The patient is a 21 year old female with a history of obesity, marijuana & tobacco use, presenting with right neck pain. Prior to falling asleep, she had smoked a rolled cigarette containing marijuana. She was awoken by right neck pain, which radiated to her right upper chest. Patient denied retching, dysphagia, odynophagia, or trauma. She presented to the ED and was hemodynamically stable & saturating on room air. Crepitus was heard over the right anterior chest & neck. The only remarkable lab finding was an elevated D-dimer at 0.70 ug/mL (ref: <0.50 ug/mL). She was admitted to the cardiology floor. CT chest with pulmonary embolism protocol revealed pneumomediastinum with air tracking into the lower neck, epicardial fat & esophagus. There was no evidence of a pulmonary embolism. She was given supplemental oxygen & her pain was controlled with analgesics. Thoracic surgery was consulted; they recommended esophagram for evaluation of esophageal microperforation. Esopghagram was unremarkable with no indication for surgical intervention. Over the course of 48 hours, the patient’s pain & crepitus resolved. On further questioning, she stated that she would forcefully inhale & hold her breath while smoking marijuana on a regular basis. Patient was counseled to discontinue marijuana & tobacco & was discharged with close follow up.

Presentation Date


Spontaneous Pneumomediastinum in a Young Female with a History of Marijuana Use