Cocaine abuse has become more affordable and popular amongst drug abusers locally in recent years. Spontaneous pneumomediastinum is an uncommon but a well-reported complication after smoking “crack” cocaine in the West. We report a case of spontaneous pneumomediastinum after smoking cocaine. The patient was managed conservatively and he recovered uneventfully. A review of literature on the mechanism, clinical presentation and management is presented.
HKSAR.Security Bureau. Narcotics Division. Central Registry of Drug Abuse Statistics [Internet].2010 [updated 2010 May 12; cited 2010 May 18]. Available from http://cs-crda.nd.gov.hk/en/enquiry_result.asp
ZhongY.Y.L., WongS.W.D., WuK.F.J.Study of cocaine abuse in Hong Kong. Report to the Narcotics Division [Internet].HKSAR: City University of Hong Kong; 2008 Nov [cited 2010 May 20]. 143p. Available from http://www.nd.gov.hk/pdf/cocaine_abuse_full_report.pdf
5.
RestrepoC.S., CarrilloJ.A., MartinezS., OjedaP., RiveraA.L., HattaA.Pulmonary complications from cocaine and cocaine-based substances: imaging manifestations. Radiographics2007; 27(4): 941–56.
6.
HaimD.Y., LippmannM.L., GoldbergS.K., WalkensteinM.D.The pulmonary complications of crack cocaine: a comprehensive review. Chest1995; 107(1): 233–40.
7.
ShannonM.Clinical toxicity of cocaine adulterants. Ann Emerg Med1988; 17(11): 1243–7.
8.
GoldbergR.E., LipumaJ.P., CohenA.M.Pneumomediastinum associated with cocaine abuse: a case report and review of the literature. J Thorac Imaging1987; 2(3): 88–9.
9.
EurmanD.W., PotashH.I., EylerW.R., PaganussiP.J., BeuteG.H.Chest pain and dyspnoea related to “crack” cocaine smoking: value of chest radiography. Radiology1989; 172(2): 459–62.
10.
MaederM., UllmerE.Pneumomediastinum and bilateral pneumothorax as a complication of cocaine smoking. Respiration2003; 70(4): 407.
11.
SullivanT.P., PiersonD.J.Pneumomediastinum after freebase cocaine use. AJR Am J Roentgenol1997; 168(1): 84.
12.
PernaV., VilaE., GuelbenzuJ.J., AmatI.Pneumomediastinum: is it really a benign entity? When it can be considered as spontaneous? Our experience in 47 adult patients. Eur J Cardiothorac Surg2010; 37(3): 573–5.
13.
MillerW.E., SpiekermanR.E., HepperN.G.Pneumomediastinum resulting from performing Valsalva maneuvers during marihuana smoking. Chest1972; 62(2): 233–4.
14.
MattoxK.L.Pneumomediastinum in heroin and marijuana users. JACEP1976; 5(1): 26–8.
15.
LiPumaJ.P., WellmanJ., SternH.P.Nitrous oxide abuse: a new cause of pneumomediastinum. Radiology1982; 145(3): 602.
ChungC.H.X-ray quiz: a young man with chest pain. Hong Kong J Emerg Med2004; 11(2): 91–3.
18.
MarascoS.F., LimH.K.Ecstasy-associated pneumomediastinum. Ann R Coll Surg Engl2007; 89(4): 389–93.
19.
KoulliasG.J., KorkolisD.P., WangX.J., HammondG.L.Current assessment and management of spontaneous pneumomediastinum: experience in 24 adult patients. Eur J Cardiothorac Surg2004; 25(5): 852–5.
20.
IyerV.N., JoshiA.Y., RyuJ.H.Spontaneous pneumomediastinum: analysis of 62 consecutive adult patients. Mayo Clin Proc2009; 84(5): 417–21.
21.
MiuraH., TairaO., HiraguriS., OhtaniK., KatoH.Clinical features of medical pneumomediastinum. Ann Thorac Cardiovasc Surg2003 Jun;9(3): 188–91.
22.
CohenA.G.Hamman's crunch: an historical note. Bull N Y Acad Med1971; 47(9): 1111–2.
23.
PanecekE.A., SingerA.J., ShermanB.W., PrescottA., RutherfordW.F.Spontaneous pneumomediastinum: clinical and natural history. Ann Emerg Med1992; 21(10): 1222–7.
24.
UvaJ.L.Spontaneous pneumothoraces, pneumomediastinum, and pneumoperitoneum: consequences of smoking crack cocaine. Pediatr Emerg Care1997; 13(1): 24–6.
KanekiT., KuboK., KawashimaA., KoizumiT., SekiguchiM., SoneS.Spontaneous pneumomediastinum in 33 patients: yield of chest computed tomography for the diagnosis of the mild type. Respiration2000; 67(4): 408–11.
27.
JougonJ.B., BallesterM., DelcambreF., Mac BrideT., DromerC.E., VellyJ.F.Assessment of spontaneous pneumomediastinum: experience with 12 patients. Ann Thorac Surg2003; 75(6): 1711–4.
