Trends in Pediatric Pneumomediastinum Following Cannabis Legalization in Massachusetts

Author Department

Surgery; Pediatrics

Document Type

Article, Peer-reviewed

Publication Date

3-2026

Abstract

Introduction: Cannabis consumption has been associated with pneumomediastinum. Although recreational cannabis is restricted to adults, its legalization has increased access to the general population. The goal of this study was to evaluate for changes in the presentation of pneumomediastinum cases in children in Massachusetts (MA) following the legalization of cannabis in November 2018.

Methods: A retrospective review was conducted of patients under 18 y of age who presented to the emergency department at a single pediatric tertiary referral center with a diagnosis of pneumomediastinum from January 1, 2014 to December 31, 2024. Excluded were diagnoses made following a traumatic injury and those whose home addresses were not in MA. Data collected included presentation year, substance use history, management, and recurrences. Parametric continuous data is shown as average/standard deviation and categorial data as frequencies/percentages. Student t-test and chi-square were used to compare data. Linear regression was used to estimate the relationship between year and incidence.

Results: In total, 56 patients met inclusion criteria. The average age at presentation was 11.8 (4.9) y. Of the patients, 46.4% were female. Among the patients, 78.6% were White, 23.4% Hispanic, 14.3% Black, 3.6% Asian, and 3.6% did not provide racial information. Three patients (5.4%) had a known history of cannabis hyperemesis syndrome. Ten patients (17.9%) endorsed cannabis use prior to presentation. There was an increase in the average number of cases per year after legalization from 3 to 6.8. Vomiting was the presenting symptom in 23.2% with no statistical difference in that rate pre-cannabis versus post-cannabis sale legalization (13.3% versus 26.8%, P = 0.38). No patient had a visualized esophageal injury on esophagram or upper gastrointestinal study, and none required procedural intervention. One patient presented with two separate instances of pneumomediastinum, and that patient had an established diagnosis of cannabis-related hyperemesis. Linear regression showed a weak positive association between year and case incidence (R2 = 0.26). Regression analysis of the pneumomediastinum cases associated with emesis showed a positive association with year of presentation with an R2 = 0.46.

Conclusions: We observed a positive correlation between legalization of cannabis in MA and an increase in incidence of pneumomediastinum in our pediatric population. As the national landscape continues to change regarding substance use policy, it is imperative that we closely monitor diseases that may be secondary to these exposures.

Keywords: Cannabis; Esophagus; Hyperemesis; Pediatric; Pneumomediastinum; Surgery.

PMID

41921469

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