BACKGROUND: Spontaneous pneumomediastinum (SPM) is an uncommon, self-limiting pathology defined as the presence of free air in the mediastinum without a traumatic cause. Factors that can lead to the development of SPM include alterations in breathing patterns such as bronchial asthma, marijuana smoking, cocaine inhalation, and barotrauma occurring with Valsalva’s maneuver.
CASE REPORT: This is a case of a previously healthy 22-year-old who presented to the Emergency Department complaining of sudden shortness of breath and chest pain after smoking a hookah for the first time. Clinical and radiological findings led to the diagnosis of pneumomediastinum, which was treated conservatively. The only apparent cause of the patient’s condition was hookah smoking.
CONCLUSIONS: SPM should be considered in patients who develop chest pain and shortness of breath after smoking a hookah. To the best of our knowledge, no previous cases of spontaneous pneumomediastinum associated exclusively with hookah smoking in a previously healthy patient have been reported in the English literature.

Keywords: Pneumomediastinum, Diagnostic, Smoking, Tomography, X-Ray