Summary

A young man presented with several days of dyspnoea and delirium due to cocaine use which was confirmed by urine drug screening. Imaging studies confirmed the diagnosis of subcutaneous emphysema, pneumorrhachis and pneumomediastinum. He was managed successfully with conservative therapy.

Although a rare clinical finding, cocaine-related pneumomediastinum, subcutaneous emphysema and pneumorrhachis should be recognised early on presentation. This will certainly help to effectively direct the use of healthcare resources and avoid subjecting the patient to unnecessary investigations.