Five Balloons of Laughing Gas Later, an 18-Year-Old’s Chest Pain Turned Out to Be Air Leaking Into His Chest and Neck

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Editorial Illustration via AI Share on Twitter Share on Facebook Share on Pocket An 18-year-old walked into a British emergency department with sharp pain in the center of his chest that shot up into his throat and got worse when he lay down. A CT scan showed air had escaped into the middle of his chest and spread well beyond it: up into his neck, out toward his armpits, in front of his breastbone, and along the front of the sac that surrounds his heart.

The likely trigger surfaced only after the scans. Questioned again, the young man said he had inhaled five balloons of nitrous oxide, the party drug better known as laughing gas, that afternoon. About six hours later, he arrived at the hospital with chest pain. Physicians at Medway Maritime Hospital in Gillingham, Kent, England, described the case in the Journal of Medical Case Reports in April 2025, under a title calling the drug “not a laughing matter anymore.”

The report is from last year, but its warning feels newly relevant in the United States. On Oct. 1, 2026, Florida began barring smoke shops and other tobacco and nicotine retailers from selling nitrous oxide, joining a growing list of states cracking down on the flavored canisters.

The condition is called pneumomediastinum. The mediastinum is “the space in the middle of the chest, between the lungs and around the heart,” according to the National Library of Medicine’s MedlinePlus.

In this patient, the scan showed extensive pneumomediastinum tracking along the cervical, axillary, presternal, and anterior pericardial regions. In plain terms, that means air in the neck, near the armpits, in front of the breastbone, and along the outside front of the heart’s protective sac. The report does not describe air inside that sac, a separate complication called pneumopericardium.

Doctors could feel the problem before they saw it. On exam, his neck had “palpable surgical emphysema,” the crackling sensation of air trapped under the skin, which also showed up on his chest X-ray.

Despite the striking images, he was stable. He was alert and speaking in full sentences, with an oxygen level of 97% on room air, a normal heart tracing, and a normal troponin, a blood marker that rises when heart muscle is damaged.

Air in the chest raises a specific worry. A tear in the esophagus, the tube that carries food from the mouth to the stomach, can leak air into the same space. MedlinePlus lists esophageal tears among the causes of pneumomediastinum and notes that such tears need surgical repair.

After talking with a specialist center, the team ordered a water-soluble contrast study, in which the patient swallows a dye that would leak out on imaging if the esophagus were torn. It showed no perforation.

That left the drug history as the leading explanation. The authors pointed to the Macklin effect, in which tiny air sacs at the ends of the lungs burst under pressure and air seeps along the airways and blood vessels into the center of the chest. Drug users routinely hold their breath forcefully while inhaling, the authors wrote, which creates the pressure gradient behind that leak. They also cited a second proposed mechanism: direct toxic effects of heat and blood vessel constriction.

One detail complicates the story. The young man also reported taking cocaine and ecstasy, and MedlinePlus lists inhaled recreational drugs such as crack cocaine among known causes of pneumomediastinum. The report’s discussion focuses on nitrous oxide and does not address whether the other drugs played a role, so a single case cannot settle which substance, or which combination, was responsible.

The ending is also unresolved. He was admitted and stayed stable, but he discharged himself against medical advice while still awaiting further tests and was lost to follow-up. The body usually absorbs leaked air slowly on its own, according to MedlinePlus, though complications such as a collapsed lung can occur.

The authors stress that this kind of injury is uncommon. They found “only a handful of case reports or series” describing similar cases, so this is not a typical outcome of laughing gas use.

The drug itself is common, though. Citing data from England and Wales, the authors noted that nitrous oxide was the second most prevalent recreational drug among young adults in 2019. On Nov. 8, 2023, Britain made it a Class C controlled drug, making possession for recreational use illegal, according to the House of Commons Library.

Their main lesson was for clinicians: the drug use came to light only after imaging, and asking about illicit drugs when taking a history helps guide management.

In the United States, the FDA issued a consumer warning against inhaling the products in March 2025 and updated it in June 2025, naming more than a dozen brands, including Galaxy Gas. The agency listed harms including vitamin B12 deficiency, paralysis, loss of consciousness, psychiatric disturbances, asphyxiation, and, in some cases, death.

Deaths have climbed. A research letter published in July 2025 in JAMA Network Open used CDC mortality data and found nitrous oxide-related deaths in the US rose from 23 in 2010 to 156 in 2023. That is a 578% relative increase, according to the University of Mississippi, where co-author Andrew Yockey is an assistant professor of public health. Co-author Rachel Hoopsick of the University of Illinois said the gas can seem “deceptively safe.”

States are now acting. Tennessee’s ban on retail sales took effect July 1, 2026. Florida’s Meg’s Law, named for Meg Caldwell, a 29-year-old who died in 2024 after buying nitrous oxide at a smoke shop, makes it a third-degree felony for tobacco and nicotine retailers to sell the gas.

The British case adds a lesser-known injury to the list. Sudden chest pain behind the breastbone that spreads to the neck, especially with crackling under the skin, warrants emergency care, and being open with doctors about what was inhaled can speed the right diagnosis.

He developed pneumomediastinum, air in the central chest space between the lungs and around the heart, after inhaling five balloons of nitrous oxide. CT also showed air spreading into his neck, toward his armpits, and in front of his breastbone.

Was the air inside the sac around his heart?

No. The scan showed air along the front of the pericardium, the sac around the heart, but the report does not describe air inside it, a different condition called pneumopericardium.

Not definitively. Doctors ruled out a torn esophagus and attributed the leak to nitrous oxide inhalation, but he had also taken cocaine and ecstasy, and inhaled drugs such as crack cocaine are a known cause.

Is this a common side effect of nitrous oxide?

No. The authors found only a handful of similar published reports. The FDA’s warning focuses on other harms, including vitamin B12 deficiency, paralysis, and loss of consciousness.

What are US states doing about nitrous oxide?

Tennessee banned retail sales as of July 1, 2026, and Florida’s Meg’s Law, effective Oct. 1, 2026, bars tobacco and nicotine retailers such as smoke shops from selling it.