Spontaneous Pneumomediastinum and Cannabinoid Hyperemesis Syndrome: A Case Report and Literature Review.

We report the case of an 18-year-old man with a six-month history of chronic marijuana use who developed spontaneous pneumomediastinum (SPM) following multiple episodes of forceful vomiting. He presented with chest pain, shortness of breath, and abdominal pain radiating to the back. A noncontrast chest CT revealed a small amount of mediastinal air without evidence of esophageal perforation, which was confirmed with a CT esophagram. He was managed conservatively with bowel rest, IV antibiotics, and supportive care. This case is one of only five to date recognizing the association between cannabinoid hyperemesis syndrome (CHS) and SPM and highlights a relatively benign condition that may not be considered in the differential diagnosis because of an uncommon underlying cause. The pathophysiology, management, and outcomes of CHS-induced SPM are discussed to place this case in context.