Cannabinoid hyperemesis syndrome complicated by pneumomediastinum: implications for pediatrics

Background. Cannabinoid hyperemesis syndrome / CHS (prolonged and frequent use of high-dose cannabis) in the pediatric population has been increasingly reported over the last decade. CHS can lead to life-threatening complications such as pneumomediastinum, which warrant careful consideration for surgical intervention. Case Presentation. A 17-year-old female with no significant past medical history presented to the emergency department with abdominal, chest and back pain (worse with deep inspiration), nausea, and vomiting for 24 hours. Upon further history, the patient reported a similar episode six months ago, being a cannabis smoker (at least once a day) in the last two years. Chest X-ray revealed a subtle abnormal lucency along the anteroposterior window and anterior mediastinum, consistent with a small amount of pneumomediastinum without any other acute intrathoracic abnormalities. Follow-up chest computed tomography with contrast showed multiple foci of air within the anterior and posterior mediastinum tracking up to the thoracic inlet. There was no evidence of contrast extravasation; however, small esophageal perforation could not be excluded. Given uncomplicated pneumomediast