Two case reports of pneumomediastinum

Abstract

Pneumomediastinum is an uncommon entity, first described almost 400 years ago. It presents with relatively non-specific symptoms and signs and will require radiological investigations to clarify the diagnosis. Treatment is conservative but will require close observation for the development of complications and occult visceral perforation. Complete resolution can be expected.

Pneumomediastinum as a complication of cocaine abuse

“…Pneumomediastinum is a recognised complication of intranasal cocaine insufflation. 5,6,11,12,14,16,21 As in our case, most patients present with pleuritic chest pain, [11][12][13] with or without tachycardia. 14,16 In the acute setting this can potentially lead to diagnostic uncertainty.…”

“…17 Another indolent presentation occurred with sudden onset neck swelling, and progressive hoarseness following cocaine use. 13 In keeping with UK data, there was a wide range of patient ages reported in the published cases series, ranging from Cocaine abuse 15-to 61-years-old. 11,18 Cocaine users often have a history of polysubstance abuse, with the concomitant use of alcohol, 10,19 nitrous oxide, 5 heroin, 14 methylene-dioxy-methamphetamine (MDMA) 13 and cannabis 13 all documented in cases of pneumomediastinum associated with cocaine.…”

“…The presenting features of pneumomediastinum secondary to intranasal cocaine use are most commonly chest pain, 5,6 often described as pleuritic in nature, [11][12][13] and/or dyspnoea. [13][14][15] These features may present without tachycardia. 14,16 One patient presented with asymptomatic surgical emphysema following cocaine insufflation without chest or retrosternal discomfort.…”

“…Pneumomediastinum is usually first identified on chest radiogram, 5,6,13 with further axial imaging in the form of a CT carried out in many cases. 6,13,16 Further imaging may be required to delineate the extent of the condition and to screen for the associated serious complications that can develop. Some clinicians advocate the use of barium swallows to rule out secondary causes of pneumomediastinum.…”

Spontaneous pneumomediastinum

“…Phentermine use has been associated with severe lung injury and pulmonary hypertension [3], but to our knowledge no cases of pneumomediastinum after oral ingestion have been reported. Inhalational drug use of amphetamines, however, has been linked to pneumomediastinum [4]. …”