Pneumomediastinum after laughing gas inhalation: not a laughing matter anymore—a case report

Abstract

Introduction: Nitrous oxide, popularly known as laughing gas, is a colorless gas with a faint, sweet odor, which has been used for recreational purposes since the nineteenth century. We present the case of an 18-year-old male who presented with spontaneous pneumomediastinum after nitrous oxide inhalation. Case presentation: An 18-year-old Caucasian British male patient presented to the emergency department complaining of sharp, central, pleuritic chest pain that radiated up to the throat and was worse on lying down. On examination, palpable surgical emphysema was noted on the neck and was noted on chest X-ray. A computed tomography of neck and chest was then performed, which revealed extensive pneumomediastinum tracking along the cervical, axillary, presternal, and anterior pericardial regions. A water-soluble contrast study was performed, which showed no evidence of esophageal perforation. Conclusion: Nitrous oxide is a substance that is widely and easily available and used recreationally for its euphoric effects. There are uncommon but significant side effects that can occur with its use; having an awareness of this and covering illicit drug use in history-taking will help guide further management plans.