Not Your Usual Pneumothorax?

You’ve been called to the ED to see a patient with a “spontaneous pneumothorax”, but once you meet him you see that he doesn’t fit the classic profile (tall, slim male). What gives?

After closer questioning, he admits to have been smoking crack cocaine at the time. Freak coincidence?

There are a number of case reports dating from 1984 describing this association. A number of reasons have been cited:

• A high incidence of tobacco smoking
• Bullous disease caused by inhaled drug use
• Inhalation of hot gas followed by frequent Valsalva maneuvers

I’ve seen this presentation about 5 times in my career. I always ask about drug use so I can ensure that a chemical dependency screen is ordered.

Reference: Pneumothorax, pneumomediastinum, and pneumopericardium following Valsalva’s maneuver during marijuana smoking. N Y State J Med 84(12):619-20, 1984.