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Pneumorachis
and pneumomediastinum caused by repeated muller's maneuvers: Complications
of marijuana smoking.
Hazouard E, Koninck JC, Attucci S, Fauchier-Rolland F, Brunereau
L, Diot P.
Department of Pneumology, INSERM EMI-U 00-10, the Laboratory of
Enzymology, INSERM EMI-U 00-10, and the Department of Radiology,
Bretonneau University Hospital, Tours, France.
Pneumomediastinum may occur during marijuana inhalation but only
rarely has pneumorachis (epidural pneumatosis or aerorachia) been
reported. The usual mechanisms that produce pneumomediastinum include
severe acute asthma, toxic-induced bronchial hyperreactivity, and
barotrauma caused by Valsalva's maneuver (expiration through resistance).
We report a case in which barotrauma resulted from repeated deep
inspiration through a device with airflow resistance equivalent
to Muller's maneuver. Inspiration occurred through a homemade apparatus
resembling a narrow outlet bong with 2 piled compartments. Pneumomediastinum
combined with subcutaneous emphysema and pneumorachis occurred,
without identified pneumothorax. There were no neurologic complications.
Because of the absence of bronchospasm, expiration either through
the apparatus or actively against a closed glottis, or apnea, this
phenomenon is likely a result of repeated Muller's maneuvers. Successive
inhalation through resistance could have resulted in extreme negative
intrathoracic pressure, which would have caused a transmural pressure
gradient inducing barotrauma and release of extrarespiratory air.
High-concentration oxygen therapy to achieve nitrogen washout was
used.
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