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A Rare Cause of Spontaneous Pneumomediastinum: Ecstasy Ingestion

How can I buy cocaine online in Kayseri

Official websites use. Share sensitive information only on official, secure websites. Ecstasy ingestion has life-threatening effects such as hyperpyrexia, rhabdomyolysis, disseminated intravascular coagulation, coma, and death. In the present report, we aimed to highlight ecstasy as a rare cause of spontaneous pneumomediastinum and its potential life-threatening effects. A year-old female with dyspnea and chest pain presented to the emergency department. Chest computed tomography demonstrated pneumomediastinum at the level of the thoracic inlet and upper and posterior mediastinum. The patient was admitted to the thoracic surgery department with a preliminary diagnosis of spontaneous pneumomediastinum. She refused to answer any questions during the first visit, an a psychiatric consultation was requested. The most important finding of psychiatric consultation was ecstasy abuse, which could not be identified in the emergency department evaluation. Four days later, the symptoms resolved completely and control chest X-rays showed no complications; therefore, the patient was discharged. While investigating the etiology of spontaneous mediastinum, particularly in a young, healthy patient, ecstasy abuse should always be considered. Because the fatal complications that may develop due to ecstasy ingestion may be overlooked. Spontaneous pneumomediastinum SPM is the existence of free air within the mediastinum without any known precipitating events, such as trauma, surgery, or medical procedures. Although it is a rare, usually benign, and self-limited condition, it is very important to detect the causes that trigger pneumomediastinum, such as exacerbation of asthma, tobacco, use of inhaled drugs, corticosteroids, emesis, cough, physical exercise, labor, and also abuse of recreational drugs such as cocaine and ecstasy \[ 1 , 2 \]. A year-old female living in an orphanage presented to the emergency department with dyspnea and chest pain. Physical examination, electrocardiogram, routine laboratory tests, and chest radiograph were all unremarkable. Chest computed tomography established pneumomediastinum at the level of the thoracic inlet and upper and posterior mediastinum Figure 1. The patient was evaluated by a general surgeon, otolaryngologist, gastroenterologist, and thoracic surgeon. Endoscopic evaluations esophagoscopy, laryngoscopy, and bronchoscopy revealed no esophageal or upper respiratory tract pathologies. The patient was admitted to the thoracic surgery department with a preliminary diagnosis of SPM for follow-up. The patient refused to communicate with the doctor or answer any questions during the first visit, and psychiatric consultation was requested. Psychiatric consultation revealed that the patient had been placed in the orphanage 3 years ago. Since then, she would become angry at everything and damage her surroundings; she was therefore taking antidepressant drugs. The patient informed that vomiting had begun after ecstasy ingestion and she suffered from dyspnea and chest pain an hour later. Axial plain computed tomography images lung window of the thorax. The patient subsequently became stable; hence, we decided to treat her conservatively. Within 4 days, the symptoms resolved and the patient was discharged with a normal chest X-ray. At a follow-up visit 1 month later, she did not present any symptoms and her chest X-ray, lung function tests, and blood gas analysis were also evaluated as normal. Ecstasy methylenedioxymethamphetamine is an amphetamine derivative that is abused for its effects such as euphoria and increased sense of well-being \[ 3 \]. Ecstasy ingestion can lead to side effects such as psychosis even after a single dose , convulsions, cerebral infarction, coma, and death \[ 3 \]. With regard to SPM, some studies have recommended outpatient treatment and follow-up for stable patients with no complications \[ 4 \]. However, if the history cannot be determined clearly, as in the present case, a short, in-hospital observation may be required. Although there are no reports of mortality directly related to SPM, the main cause of SPM, such as ecstasy ingestion, may lead to significant and potentially life-threatening complications including hyperpyrexia, rhabdomyolysis, hepatitis, ARDS, ketoacidosis, as well as disseminated intravascular coagulation resulting in acute renal failure \[ 5 \]. Valsalva maneuvers known to cause SPM include coughing, sneezing, vomiting, defecation, inhalation of cocaine, giving birth, and blowing up party balloons \[ 6 \]. In the present case, presence of mediastinal air was most likely due to positive pressure or prolonged Valsalva maneuvers that trigger microscopic esophageal tears, finally causing air leakage into the mediastinal space, as supported in the literature \[ 7 , 8 \]. We believe that in the present case, the cause of SPM was not pharmacological or dose related but related to the Valsalva maneuvers associated with the vomiting induced by the drug \[ 9 , 10 \]. No pathologies were detected to explain the cause of vomiting. The underlying mechanism remains unknown, although the direct pharmacological effects of ecstasy on the respiratory system, which increases the intrathoracic pressure, or drug-induced vomiting can be considered \[ 2 , 9 , 10 \]. Usually surgical treatment is not necessary in patients with pneumomediastinum and pneumopericardium. In most cases, observation and monitoring are enough to evaluate spontaneous healing. Small pneumothoraxes can resolve with oxygen therapy. However, when large pneumothoraces are detected, tube thoracostomy is mandatory to prevent tension pneumothorax. In the present case, conservative treatment was adequate for healing. Although SPM is mostly a self-limited condition, observation is necessary until the symptoms and radiographic changes disappear. This is because the fatal complications that may develop because of this drug may be overlooked. Informed Consent: Written informed consent was obtained from patients who participated in this study. Financial Disclosure: The authors declared that this study has received no financial support. As a library, NLM provides access to scientific literature. Turk Thorac J. Open in a new tab. Peer-review: Externally peer-reviewed. Conflict of Interest: No conflict of interest was declared by the authors. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

How can I buy cocaine online in Kayseri