Yu Irene, Tung Kaity, Dugan Ryanne, Qaqish Robert Thamer, Perry Yaron
Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, The State University of New York, Buffalo, NY, United States.
Division of Thoracic Surgery, Buffalo General Medical Center, Buffalo, NY, United States.
Front Surg. 2023 Feb 16;10:1043729. doi: 10.3389/fsurg.2023.1043729. eCollection 2023.
Marijuana use has become more common since its legalization, as have reports of marijuana-associated spontaneous pneumomediastinum. Non-spontaneous causes such as esophageal perforation are often ruled out on presentation due to the severe consequences of untreated disease. Here we seek to characterize the presentation of marijuana-associated spontaneous pneumomediastinum and explore whether esophageal imaging is necessary in the setting of an often benign course and rising healthcare costs.
Retrospective review was performed for all 18-55 year old patients evaluated at a tertiary care hospital between 1/1/2008 and 12/31/2018 for pneumomediastinum. Iatrogenic and traumatic causes were excluded. Patients were divided into marijuana and control groups.
30 patients met criteria, with 13 patients in the marijuana group. The most common presenting symptoms were chest pain/discomfort and shortness of breath. Other symptoms included neck/throat pain, wheezing, and back pain. Emesis was more common in the control group but cough was equally prevalent. Leukocytosis was present in most patients. Four out of eight of computed tomography esophagarams in the control group showed a leak requiring intervention, while only one out of five in the marijuana group showed even a possible subtle extravasation of contrast but this patient ultimately was managed conservatively given the clinical picture. All standard esophagrams were negative. All marijuana patients were managed without intervention.
Marijuana-associated spontaneous pneumomediastinum appears to have a more benign clinical course compared to non-spontaneous pneumomediastinum. Esophageal imaging did not change management for any marijuana cases. Perhaps such imaging could be deferred if clinical presentation of pneumomediastinum in the setting of marijuana use is not suggestive of esophageal perforation. Further research into this area is certainly worth pursuing.
自大麻合法化以来，其使用变得更为普遍，与大麻相关的自发性纵隔气肿的报告也同样增多。由于未治疗疾病的严重后果，诸如食管穿孔等非自发性病因在就诊时往往被排除。在此，我们旨在描述大麻相关自发性纵隔气肿的表现，并探讨在病程通常为良性且医疗成本不断上升的情况下，食管成像是否必要。
对2008年1月1日至2018年12月31日期间在一家三级医疗中心接受评估的所有18至55岁纵隔气肿患者进行回顾性研究。排除医源性和创伤性病因。将患者分为大麻组和对照组。
30名患者符合标准，其中大麻组13名。最常见的症状是胸痛/不适和呼吸急促。其他症状包括颈部/喉咙疼痛、喘息和背痛。呕吐在对照组中更常见，但咳嗽的发生率相同。大多数患者存在白细胞增多。对照组8例计算机断层扫描食管造影中有4例显示有渗漏需要干预，而大麻组5例中只有1例显示可能有轻微造影剂外渗，但鉴于临床表现，该患者最终采用保守治疗。所有标准食管造影均为阴性。所有大麻患者均未进行干预。
与非自发性纵隔气肿相比，大麻相关自发性纵隔气肿的临床病程似乎更为良性。食管成像对任何大麻病例的治疗管理均无改变。如果在大麻使用背景下纵隔气肿的临床表现不提示食管穿孔，或许可以推迟此类成像检查。对该领域进行进一步研究当然值得。
