Pneumomediastinum as a complication of cocaine abuse

Abstract

A 26-year-old male presented with a 24-hour history of pleuritic chest pain following intranasal cocaine insufflation. He was a smoker, cannabis and alcohol user. Cardiovascular and respiratory examinations were unremarkable. His admission blood tests were within normal limits. The admission electrocardiogram (ECG) showed sinus rhythm, with ST-segment elevation in an inferolateral distribution. This appeared to be an early repolarisation abnormality, with no evolving changes. His chest radiogram showed a double outline at the left heart border with subcutaneous gas collection over the left supraclavicular fossa but no evidence of pneumothorax. A computed tomography (CT) showed prominent mediastinum with gas tracking into the neck but no connection to the oesophagus or pneumothorax. He was managed conservatively and a repeat chest radiogram after 48 hours showed improvement.

A Case Report of Secondary Spontaneous Pneumomediastinum Induced by Vaping

“…There have been several cases of vaping associated spontaneous pneumothorax (VASP) reported in the literature [4]. There have also been reported cases of spontaneous pneumomediastinum in young patients caused by inhalation of marijuana [2,5] and crack cocaine [6,7]. Vaping-induced pneumomediastinum is a less commonly reported phenomenon, with only four other cases reported in the literature [3,[8][9][10].…”

“…In the majority of cases, spontaneous pneumomediastinum is a self-limiting condition requiring only supportive care with proper pain control, antitussives, and imaging studies to confirm resolution. Patients are typically hemodynamically stable and can be admitted for short inpatient observation [2,3,5,[7][8][9][10]. The diagnosis of spontaneous pneumomediastinum is largely one of exclusion and is confirmed with imaging.…”