Sudden dyspnea and chest pain in an adolescent: an unexpected diagnostic outcome

Abstract

Introduction: Acute onset of chest pain and dyspnea in adolescents is an emergency and often a diagnostic challenge. In the differential diagnosis, one of the possible causes of a sudden onset of chest pain and dyspnea is spontaneous pneumomediastinum (SPM). The most common causes of SPM are asthma exacerbation and lower respiratory tract infections. Other predisposing causes are trauma, vomiting, cough, Valsalva maneuver, helium inhalation from a balloon, use of e-cigarettes and vape devices, and drug inhalation. We will present a case of sudden onset of chest pain in an adolescent caused by SPM, which we believe was caused by the consumption of an e-cigarette or vape device.

Case report: A 17-year-old male was examined in the pediatric emergency department due to the sudden onset of stabbing chest pain lasting one day, with shortness of breath and a dry cough. From the anamnestic data, we learn that the pain first occurred during physical exertion (stacking wood) and that he smokes an e-cigarette. He denies allergies and asthma. He had not been recently ill. Upon examination, the young man was in good general condition, with cardiopulmonary compensation and normal oxygen saturations on room air, and was afebrile. The chest was sensitive to palpation in the sternum area, with no signs of subcutaneous emphysema. Auscultation revealed normal breath sounds and normal lung sounds on percussion. Radiological work-up (heart and lung X-ray, MSCT of the chest) revealed pneumomediastinum, from the soft tissues of the neck almost to the diaphragm. Laboratory work-up revealed a slightly elevated CRP with a normal complete blood count, acid-base status, normal immunoglobulin, and alpha-antitrypsin values. Skin prick test for inhaled allergens was negative for all tested allergens. He was hospitalized for further observation. Symptomatic therapy and rest were continued during the stay, and gradual recovery of symptoms was monitored. In conclusion, we believe that this is a spontaneous pneumomediastinum most likely caused by the consumption of an e-cigarette or vape device. He is discharged home with recommendations for rest, the use of analgesics as needed, and avoidance of e-cigarette and vape device consumption.

Conclusion: SPM caused by the use of vape devices is rare, but with the increasing consumption of such devices, its incidence is increasing, especially in adolescents and young adults. It is known from the literature that the use of vape devices is also associated with more severe clinical conditions, such as spontaneous pneumothorax, pneumorrhagia, and diffuse alveolar hemorrhage, which shows that the use of vape devices in patients with sudden chest pain is an important anamnestic data point.