title: Subcutaneous emphysema and pneumomediastinum following cocaine inhalation: a case report.
abstract: BACKGROUND
  Subcutaneous 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.
  
  
  METHODS
  Here, 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Campbelltown Hospital, University of Western Sydney, Goldsmith Avenue, Campbelltown, NSW, 2560, Australia. deanne.soares@gmail.com.
authors.forename: Deanne S
authors.initials: DS
authors.lastname: Soares
authors.affiliation: Campbelltown Hospital, University of Western Sydney, Goldsmith Avenue, Campbelltown, NSW, 2560, Australia. aferdman@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Ferdman
authors.affiliation: Campbelltown Hospital, University of Western Sydney, Goldsmith Avenue, Campbelltown, NSW, 2560, Australia. rozanna_a@hotmail.com.
authors.forename: Rozanna
authors.initials: R
authors.lastname: Alli
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D008297:Male; D008478:Mediastinal Emphysema / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic; D013352:Subcutaneous Emphysema / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D013287:Illicit Drugs