Abstract
Pneumothorax, pneumomediastinum and/or subcutaneous emphysema are important differential diagnosis for patients manifesting dyspnea or chest pain in the emergency department (ED). Inhalation of methamphetamine as well as other abuse substances could rarely induce above-noted complications. However, most ED patients are reluctant to reveal the use of illicit substances. Therefore, prompt toxicologic screening is warranted in confirming the diagnosis of substance abuse in the ED. We herein report a 22-year-old male patient who presented to the ED with diffuse subcutaneous emphysema, pneumomediastinum and pneumothorax after methamphetamine inhalation. The diagnosis of methamphetamine abuse was delayed because the patient did not provide the accurate drug exposure history at the outset. With the help of appropriate toxicologic screening, the diagnosis was finally made and early counseling was provided to prevent further drug abuse and the recurrence of pneumothorax/ pneumomediastinum.