E-Cigarette or Vaping-Associated Pneumomediastinum: A Case Report and Pathophysiological Explanation

Abstract

We report the case of a 16-year-old male who presented to the emergency room with chest pain, fever and shortness of breath. Upon physical examination Hamman’s sign was positive. The patient was diagnosed with spontaneous pneumomediastinum, most probably caused by e-cigarette use and/or asthma exacerbation. He was treated with nebulizations with salbutamol, corticosteroids and antibiotics and made a full recovery.

This case adds to the evidence of e-cigarette or vaping-associated pneumomediastinum in adolescents. We identified three mechanisms by which vaping can cause pneumomediastinum: the act of smoking itself, through alveolar damage as part of e-cigarette or vaping product use-associated lung injury or, in a secondary way, by triggering an asthma exacerbation.

This case highlights the importance for pediatricians to ask about the use of e-cigarettes in adolescents presenting with chest pain, gastro-intestinal, constitutional and/or respiratory complaints. It also shows that we must educate our patients about the risks of e-cigarette use whenever the opportunity is there. Spontaneous pneumomediastinum should be considered in the differential diagnosis of adolescents with chest pain who use e-cigarettes.