# Spontaneous pneumomediastinum and surgical emphysema presenting as rhinolalia following ecstasy ingestion: a case report

## TL;DR

A young man developed a rare lung condition after taking ecstasy, with the first sign being a voice change called rhinolalia.

## Contribution

This case report highlights rhinolalia as a novel initial symptom of pneumomediastinum and surgical emphysema following drug use.

## Key findings

- Rhinolalia was the first recognizable sign of pneumomediastinum and surgical emphysema in a patient who used ecstasy.
- Conservative management led to full resolution of pneumomediastinum and surgical emphysema within three days.
- The patient's voice returned to normal as his condition improved.

## Abstract

We present a unique case of rhinolalia as the first recognizable sign of spontaneous pneumomediastinum and surgical emphysema following drug use.

This case presents a 17-year-old white male experiencing rhinolalia following ecstasy ingestion at a rave. Subsequent chest X-ray revealed extensive surgical emphysema, along with a continuous diaphragm sign indicative of pneumomediastinum. Computed tomography confirmed the diagnosis. The patient was managed conservatively with strict monitoring and 6 hourly electrocardiograms. Follow-up computed tomography on day 3 showed resolution of pneumomediastinum and surgical emphysema, and the patient was safely discharged. Notably, the patient experienced a temporary rhinolalia during the acute phase, which resolved spontaneously as his condition improved.

This case underscores the importance of considering spontaneous pneumomediastinum and surgical emphysema in the differential diagnosis of young individuals presenting with acute symptoms after drug use.