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Case report
Pneumomediastinum and subcutaneous emphysema: complication of cocaine use
  1. Filipa de Sousa Costeira,
  2. Filipa Vieira,
  3. Fernanda Marta Gomes and
  4. Carolina Leite
  1. Department of Radiology, Hospital de Braga, Braga, Portugal
  1. Correspondence to Dr Filipa de Sousa Costeira; filipacosteira{at}


Pneumomediastinum is more frequent in young men and usually presents in association with subcutaneous emphysema. It can occur in case of oesophageal or chest trauma, be iatrogenic or develop spontaneously, in case of emesis, coughing or forceful straining. Use of illicit drugs, such as cocaine, has been associated with multiple respiratory complications, including pneumomediastinum and subcutaneous emphysema. The pathogenesis of subcutaneous emphysema and pneumomediastinum after cocaine inhalation is not completely known, but it is thought that the physical manoeuvers used to increase its absorption and effect may lead to alveolar rupture, resulting in air escaping into the mediastinum and fascial planes of the neck and chest. Chest X-ray is usually diagnostic, but CT can be used as complementary study, allowing evaluation of adjacent structures. A case of pneumomediastinum and subcutaneous emphysema after cocaine inhalation in an otherwise healthy man is presented.

  • respiratory system
  • drug misuse (including addiction)
  • toxicology
  • unwanted effects / adverse reactions
  • pneumomediastinum

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  • Contributors FdSC was the author of the manuscript and collected and reviewed the data. FV reviewed the manuscript and supervised image selection. FMG helped to collect the data and reviewed the manuscript. CL was the radiologist responsible for diagnosis establishment, suggested the case report and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.