Spontaneous Pneumomediastinum and Subcutaneous Emphysema: A Rare Complication Associated With Cocaine Consumption

Spontaneous pneumomediastinum (SPM) is a rare clinical entity typically associated with underlying pulmonary disease or trauma. However, it has also been linked to illicit drug use, with cocaine being one of the most common. We present the case of a previously healthy 23-year-old patient who arrived at the emergency department with retrosternal pain, odynophagia, dyspnea, and crepitus in the neck and chest after inhaling cocaine for three consecutive days. The patient was hemodynamically stable, with extensive subcutaneous emphysema in the neck and chest. Computed tomography of the neck and chest revealed abundant air dissecting the superficial and deep planes of the neck and mediastinum, particularly in its upper and middle portions. Additional studies included nasolaryngoscopy, which showed white material suggestive of inhaled substance use. An upper gastrointestinal endoscopy was performed to rule out perforation, which did not identify any lesions. Blood tests showed no abnormalities. Conservative management with analgesia and monitoring was initiated, resulting in the improvement of subcutaneous emphysema and pain. The patient was discharged after a two-day hospital stay. There were no complications or further visits to the institution within the following six months. This case highlights the importance of investigating a history of illicit drug use, particularly cocaine, in cases of spontaneous pneumomediastinum. Our findings support the generally benign course of this condition and the effectiveness of conservative management in the absence of complications.