Pneumomediastinum, Pneumopericardium, and Pneumothorax: An Uncommon Triad Induced by Cocaine Use

We present a rare case of a clinically stable 24-year-old male patient who developed acute central chest pain shortly after intranasal cocaine use. Initial chest imaging revealed pneumomediastinum, a small apical pneumothorax, and pneumopericardium-three uncommon yet potentially serious findings. Remarkably, the patient was hemodynamically stable with unremarkable clinical examination and vital signs. High-resolution computed tomography (CT) of the thorax and abdomen with oral and intravenous contrast effectively excluded esophageal rupture, a critical differential diagnosis requiring surgical intervention. The patient was successfully managed with conservative measures including observation and supportive care. Serial imaging demonstrated progressive improvement, with complete radiological resolution confirmed at follow-up. This case underscores the need for clinicians to consider recreational drug use as a cause of thoracic barotrauma, utilize imaging judiciously to exclude life-threatening conditions, and recognize that conservative management may be appropriate in carefully selected, clinically stable patients.