Clinical Course and Outcome of Cocaine-Induced Pneumomediastinum

Alnas, Majd; Altayeh, Abdullah; Zaman, Mumtaz U.

doi:10.1097/maj.0b013e3181c371da

Cited by 37 publications

(35 citation statements)

References 26 publications

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“…It may then travel through the neural formamina into the epidural space. Air thus freely communicates via the neural foramina and collects in the epidural space 1–3. This case illustrates a previously unreported complication of cocaine use and highlights the difficulty in differentiating between oesophageal perforation which produces similar clinical and radiological appearances.…”

Section: Descriptionmentioning

confidence: 84%

Epidural pneumatosis as a consequence of cocaine use

Malik

Mohandas²,

Mukherjee³

2012

Case Reports

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DESCRIPTIONA previously healthy 22-year-old gentlemen was referred to the surgical department following acute onset epigastric pain. The initial onset of pain was followed by an episode of vomiting and wretching lasting an hour. On examination, although the abdomen was tender in the epigastrium there was no evidence of peritonitis. Crepitus was evident in the neck and anterior chest wall due to extensive subcutaneous emphysema. Plain radiographs illustrated linear lucencies tracking in the neck and chest, but no pneumothorax or free intra-abdominal air. CT illustrated marked subcutaneous emphysema throughout the mediastinum and neck (fi gures 1 and 2). Furthermore free air was identifi ed in the spinal canal. Gastroscopy and contrast swallow did not identify any oesophageal perforation. After further careful history taking, the patient admitted cocaine abuse. The patient was treated conservatively and symptoms resolved after 48 h. The mechanism of cocaine-induced subcutaneous emphysema is believed to be secondary to barotrauma; after deep inhalation and Valsalva maneouvre in order to increase uptake and the euphoriant effect, or cough triggered by the sniffed substance. This resulting increased intra-alveolar pressure causes rupture of a distended alveolus into the lung interstitium. Air then dissects along the pulmonary vasculature toward the hilum and then extravasates into the posterior mediastinum. It may then travel through the neural formamina into the epidural space. Air thus freely communicates via the neural foramina and collects in the epidural space. 1 -3 This case illustrates a previously unreported complication of cocaine use and highlights the diffi culty in differentiating between oesophageal perforation which produces similar clinical and radiological appearances. Learning points▶ Pneumomediastinum as a result of oesophageal perforation carries a signifi cantly poorer prognosis then following drug abuse, with death rates of between 10% and 60%. Thus it is crucial to carefully rule out gastrointestinal ▶ perforation as a cause in order to implement appropriate management immediately.

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Section: Descriptionmentioning

confidence: 84%

Epidural pneumatosis as a consequence of cocaine use

Malik

Mohandas²,

Mukherjee³

2012

Case Reports

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“…Management was conservative in this instance and similar cases report favorable outcomes from antibiotics, fluids and observation although rarely mediastinal shift or fluid collection mandates surgical exploration or chest tube placement [15]. We could have taken serial radiographs to ensure air was being resorbed, though daily clinical review was a reasonable alternative strategy.…”

Section: Discussionmentioning

confidence: 96%

Subcutaneous emphysema in a case of infective sinusitis: a case report

Zakaria

Khwaja

2010

J Med Case Reports

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IntroductionSubcutaneous emphysema with pneumomediastinum is a rare phenomenon with a high morbidity and may occur spontaneously.Case presentationA 30-year-old Caucasian man presented with sudden onset of a painful, swollen neck and was found, via clinical and radiological examination to have subcutaneous emphysema. A swallow study showed no oesophageal perforation. Computed tomography of his neck and thorax demonstrated pneumomediastinum but no other pathology. Management was conservative with intravenous antibiotics, fluids and no oral intake. He had a history of a productive cough and a flexible nasoendoscopy found purulent sinusitis which was treated with topical nasal washes. The patient was discharged after 72 hours and will be followed up by the otolaryngology-head and neck service.ConclusionsInfective sinusitis is a rare cause of subcutaneous emphysema and pneumomediastinum. It may be managed conservatively provided there is early recognition and exclusion of more serious pathology, such as a ruptured trachea or oesophagus.

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“…SPM has been associated with activities requiring a Valsalva manoeuvre, asthma and inhalational drug use such as cocaine 2. Following such drug use, it is thought that the predisposing factor is prolonged and forceful breath holding rather than a direct pharmacological effect.…”

Section: Discussionmentioning

confidence: 99%

“…Pneumomediastinum is a rare complication of recreational drug use, most commonly seen following cocaine inhalation 1 2. This case highlights the importance of a full-history including specific drug use and to consider this unusual but important differential diagnosis in a young person presenting with pleuritic chest pain.…”

Section: Introductionmentioning

confidence: 89%

Pneumomediastinum secondary to mephedrone inhalation

2013

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A 23-year-old man presented to the emergency department with severe, central, pleuritic chest pain. The pain was present on waking and exacerbated by movement. On examination, supraclavicular and anterior chest wall surgical emphysema was noted, otherwise examination and initial observations were normal. A chest x-ray and subsequent chest CT demonstrated a pneumomediastium with significant subcutaneous emphysema. There was no history of vomiting or chest trauma, but the patient had inhaled mephedrone, a synthetic stimulant drug, 36 h prior. Pneumomediastinum is an uncommon complication of inhalational drug use.

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Clinical Course and Outcome of Cocaine-Induced Pneumomediastinum

Cited by 37 publications

References 26 publications

Epidural pneumatosis as a consequence of cocaine use

Epidural pneumatosis as a consequence of cocaine use

Subcutaneous emphysema in a case of infective sinusitis: a case report

Pneumomediastinum secondary to mephedrone inhalation

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