PMC9696622_01
Initial chest x-ray with evidence of pneumomediastinum in the setting of cannabinoid hyperemesis syndrome.. Note: Subtle abnormal lucency observed along the anteroposterior window and anterior mediastinum, consistent with a small amount of pneumomediastinum (arrows). Cardiomediastinal silhouette is normal in size. Pulmonary vasculature and hilar contours are within normal limits. Lungs are adequately expanded with no interstitial airspace opacity, pleural effusion, or discernible pneumothorax.
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F1
Chest X-ray revealed a subtle abnormal lucency along the anteroposterior window and anterior mediastinum, consistent with a small amount of pneumomediastinum without any other acute intrathoracic abnormalities (Figure 1).
Chest computed tomography (CT) with contrast confirms evidence of pneumomediastinum.. Note: Multidetector multiplanar CT images of the chest were obtained after administration of 70 mL iohexol IV contrast material. Foci of air were observed within the anterior and posterior mediastinum tracking up to the thoracic inlet (arrows), consistent with pneumomediastinum. There was no evidence of contrast extravasation; however, small esophageal perforation could not be excluded.
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F2
Follow-up chest computed tomography (CT) with IV contrast showed multiple foci of air within anterior and posterior mediastinum tracking up to the thoracic inlet (Figure 2).
Esophagram revealed no signs of extravasation, indicating lack of esophageal perforation.. Note: Following preliminary chest radiograph, the patient orally ingested water-soluble contrast solution, after which multiple fluoroscopic spot images were obtained. The esophagus was in normal position, without thickened folds, filling defect, abnormal contrast collection, or stricture. Normal peristalsis was observed under fluoroscopy.
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F3
This was further confirmed with a fluoroscopic esophageal swallow test using water soluble contrast which showed no evidence of contrast extravasation (Figure 3).