title: [Pneumomediastinum and cocaine use].
abstract: BACKGROUND
  In France, cocaine is the second most commonly used illicit drug after cannabis. It can be responsible for many respiratory disorders among which pneumomediastinum.
  
  
  OBJECTIVE
  Systematic literature review of data on pneumediastinum in cocaine users. Documentary sources. Medline, on the period 1980-2016 with the keywords "pneumomediastinum" and "cocaine" or "free-base" or "freebasing" or "crack"; limits "title/abstract"; the selected languages were English or French. Among 72 articles, 48 abstracts have given use to a dual reading to select 37 studies.
  
  
  RESULTS
  Thirty-five selected articles related 44 subjects (sex-ratio: 5.2) whose age ranged from 15 to 36 years. Fourteen subjects used cocaine nasally and 30 others smoked it (12 as free-base and 18 in the form of crack). Thirty-two subjects had an isolated pneumomediastinum and 12 others had a pneumomediastinum combined with other gaseous effusions (pneumothorax, pneumopericardium, pneumoperitoneum or pneumorachis). Chest pain of sudden onset in the most common symptom which is often associated with tightness or swelling of the neck; more rarely there are dyspnea and/or a dry cough. The time between taking cocaine and the onset of the symptoms varies from a few minutes to 3 days. The course is usually good with healing in 1 to 4 days.
  
  
  CONCLUSIONS
  Cocaine use may be responsible for spontaneous pneumomediastinum. Practitioners must seek cocaine use in case of pneumomediastinum in a young person and consider the diagnosis in the case of sudden chest pain in cocaine users; they must help them to stop their consumption.
authors.affiliation: Centre hospitalier Henri-Laborit, unité de recherche clinique, 86000 Poitiers, France. Electronic address: mike.underner@orange.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Underner
authors.affiliation: Centre de tabacologie, dispensaire Émile-Roux, 63100 Clermont-Ferrand, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Perriot
authors.affiliation: CHR Metz-Thionville, service de pneumologie, 57038 Metz, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Peiffer
mesh_terms: D019970:Cocaine-Related Disorders / Q000150:complications*; D006801:Humans; D008478:Mediastinal Emphysema / Q000139:chemically induced* / Q000175:diagnosis