Case Report Pneumomediastinum following Crystal Use: A Report of Two Cases Samiramis Pourmotabed 1 and Mohammad Jalili 2 1 Department of Emergency Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran 2 Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran Correspondence should be addressed to Samiramis Pourmotabed; samiramispm@yahoo.com Received 15 December 2015; Accepted 16 March 2016 Academic Editor: Aristomenis K. Exadaktylos Copyright © 2016 S. Pourmotabed and M. Jalili. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Crystal is a synthetic substance with an increasing rate of abuse. It may cause patients to present to the emergency department because of its acute complications. We depict two cases of pneumomediastinum following inhalation of crystal. Both cases had used crystal for recreational purposes. In one case, a young man presenting to the ED with the retrosternal chest pain and neck pain was diagnosed to have pneumomediastinum and pneumopericardium. Te other patient presenting with dyspnea and chest pain was shown to have collection of air within mediastinum. Both patients underwent a series of diagnostic evaluations and, afer a course of observation, were discharged without a surgical intervention. Patients with chest pain following inhalation of crystal may sufer from this complication. 1. Introduction Crystal methamphetamine (CM) is a colorless, odorless form of d-methamphetamine, a powerful and highly addictive synthetic stimulant [1]. Also known as meth, speed, ice, tina, crystal, tweak, crank, and glass, CM is a methamphetamine powder that can be white, yellow, orange, pink, or brown [2]. It is typically smoked using glass pipes [1]. Te abuse of CM has reached epidemic proportions in the United States, with widespread health consequences for a wide segment of the population [2]. Its use is associated with rapid heart rate, increased blood pressure, damage to the small blood vessels in the brain, hyperthermia, convulsions, violent behavior, paranoia, anxiety, confusion, insomnia, and death [1]. Spontaneous pneumopericardium as well as pneumome- diastinum, sometimes called pericardial-mediastinal emphy- sema, is a very rare condition resulting from a multitude of causes: parturition, pulmonary barotrauma, severe cough, asthma, cocaine inhalation, emesis, athletics [3], chlorine gas exposure [4], and certain chemicals inhalation [5, 6]. Isolated cases of pneumomediastinum have been re- ported following the inhalation of marijuana and cocaine use [7]. Here we describe two cases of spontaneous pneumomediastinum following inhalational consumption of crystal. 2. Case Report 2.1. Case One. A 24-year-old man presented to the emer- gency department (ED) complaining of neck and retrosternal chest pain. He reported using inhalational crystal 4 hours ago, when he suddenly felt chest pain and shortness of breath. He did not report any trauma or prolonged cough. He explained that this was the fourth time he was using the drug and he did not have similar problems during previous uses. On physical examination, the vital signs were normal except for slight tachypnea (RR = 18). Oxygen saturation at room air was 94%. Tere was severe tenderness on neck palpation without crepitation. Chest auscultation was unremarkable. Intravenous line was placed; the patient was put on nasal oxygen while being monitored for heart rate and oxygen saturation. Electrocardiogram (ECG) was performed which was completely normal. Te chest X-ray showed accumu- lation of air within pericardium with no tracheal deviation (Figure 1). Esophageal barium swallow and chest and neck Hindawi Publishing Corporation Case Reports in Emergency Medicine Volume 2016, Article ID 9730484, 3 pages http://dx.doi.org/10.1155/2016/9730484