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Pneumomediastinum in marijuana users: a retrospective review of 14 cases
  1. Zoe Freeman Weiss1,
  2. Sara Gore2 and
  3. Andrew Foderaro3
  1. 1 Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
  2. 2 Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon, USA
  3. 3 Division of Pulmonary and Critical Care and Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr Zoe Freeman Weiss; zoefreemanweiss{at}


Introduction Inhaled marijuana has been infrequently identified as a potential risk factor for the development of spontaneous pneumomediastinum (SPM), a rare finding of free air in the mediastinum likely caused by barotrauma during breathing manoeuvres. The mechanism of inhalation drug use is often not ascertained by physicians, thus little is known about how different smoking techniques precipitate pulmonary injury. We aimed to evaluate the frequency of marijuana use in patients with non-traumatic pneumomediastinum over a 12-month period, identifying additional relevant clinical features or risk factors, and determining the extent to which clinicians record smoking techniques.

Methods We performed a retrospective chart review over a 1-year period, identifying patients presenting to the hospital with a diagnosis of pneumomediastinum in the absence of trauma, malignancy or iatrogenic cause.

Results We identified 21 cases, 14 of which (66.7%) were associated with marijuana use, average age was 22.5 years (range 18–30), with male predominance (64.2%). Daily or more use was reported in 50% of cases. Concurrent risk factors including vomiting (57.1%) and coughing (42.9%) were commonly present. The mechanism of smoking was described in only two cases (14.3%).

Discussion Inhaled marijuana may be an underappreciated risk factor for the development of SPM, caused by air leakage around the bronchovascular sheaths during successive inhalation through a high-resistance smoking apparatus or forced exhalation against a closed glottis. Physicians should be aware of this association in order to provide appropriate counselling. Further research is needed to direct the safe use of smoking devices and techniques.

  • spontaneous pneumomediastinum
  • marijuana
  • barotrauma
  • subcutaneous emphysema

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors ZFW wrote the manuscript, performed data collection and analysis. SG assisted with data collection. AF supervised data collection and contributed to final manuscript. All authors discussed the results and contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This project was approved by the Rhode Island Hospital Institutional Review Board (IRB).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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