Abstract
IntroductionSubcutaneous emphysema or pneumomediastinum can occur as a complication of illicit drug use although this is rare. When occurring without a pneumothorax and spontaneously, it is usually treated conservatively, but can have serious consequences.Case presentationHere, we present the case of an otherwise healthy 23-year-old Caucasian man who presented to the Emergency Department at our institution and was found to have both subcutaneous emphysema and pneumomediastinum as a result of cocaine use. His only presenting symptom was mild chest pain and he had palpable subcutaneous crepitations. He underwent a series of investigations including a chest radiograph and computed tomography as well as a barium fluoroscopy study to rule out secondary pneumomediastinum, which can be fatal. There were no other pulmonary features of illicit drug use, such as granulomas or fibrosis, seen on radiological imaging. He was subsequently managed with a period of observation and supportive care.ConclusionWe report a rare case of subcutaneous emphysema and pneumomediastinum likely due to the nasal insufflation of cocaine. We discuss the necessary investigations to rule out any serious underlying pathology. These should be considered in patients who present with chest pain after cocaine use.
Highlights
Subcutaneous emphysema or pneumomediastinum can occur as a complication of illicit drug use this is rare
We report a rare case of subcutaneous emphysema and pneumomediastinum likely due to the nasal insufflation of cocaine
We discuss the necessary investigations to rule out any serious underlying pathology. These should be considered in patients who present with chest pain after cocaine use
Summary
Spontaneous subcutaneous emphysema and pneumomediastinum can usually be managed conservatively without any surgical intervention. Appropriate investigations are recommended to exclude serious pathology such as esophageal perforation or pneumopericardium. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests The authors declare that they have no competing interests. Authors’ contributions DSS was part of the team that managed this patient and was the main author of the report. AF and RA were major contributors to the writing of the manuscript. All authors read and approved the final manuscript
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