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A 16-year-old girl with no medical history presented to our emergency department with rapid onset and progressive facial and neck swelling, dyspnoea and dysphonia. The previous night she had attended a nightclub, had sniffed ketamine and inhaled nitrous oxide. On examination she had swelling of her face, neck and upper torso with palpable crepitus. Scattered bilateral expiratory wheeze was present on auscultation. She was mildly tachycardic and tachypnoeic but other observations were normal. Neurological examination was normal. A chest radiograph demonstrated extensive subcutaneous emphysema. CT scan of the neck, chest and abdomen without intravenous contrast confirmed the presence of extensive subcutaneous gas within …
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