Atypical Presentation of Spontaneous Pneumomediastinum Secondary to Cannabinoid Hyperemesis Syndrome.

Spontaneous pneumomediastinum (SPM) is a rare condition that typically affects young adult males and is often precipitated by acute increases in intrathoracic pressure. We report a 20-year-old male with cannabinoid hyperemesis syndrome (CHS) who developed SPM. He presented with persistent vomiting, notably without classic symptoms such as chest pain, dyspnea, or subcutaneous emphysema. Imaging revealed moderate pneumomediastinum, bilateral pulmonary lacerations, and a small left apical pneumothorax. Conservative management with supportive care resulted in full clinical recovery. This case highlights an atypical presentation of SPM and underscores the role of repetitive vomiting and recreational drug use as precipitating factors. This case also demonstrates that significant radiographic findings can occur even in minimally symptomatic patients. Awareness of atypical presentations and associated risk factors is critical for timely diagnosis and appropriate management. Clinicians should maintain a high index of suspicion for SPM in patients with CHS, even in the absence of chest pain.