PT - JOURNAL ARTICLE AU - Catriona Macrae AU - Christopher Brown AU - Christine Aiken AU - Ravi Jamdar TI - Pneumomediastinum as a complication of cocaine abuse AID - 10.7861/clinmedicine.19-4-321 DP - 2019 Jul 01 TA - Clinical Medicine PG - 321--324 VI - 19 IP - 4 4099 - http://www.rcpjournals.org/content/19/4/321.short 4100 - http://www.rcpjournals.org/content/19/4/321.full SO - Clin Med2019 Jul 01; 19 AB - A 26-year-old male presented with a 24-hour history of pleuritic chest pain following intranasal cocaine insufflation. He was a smoker, cannabis and alcohol user. Cardiovascular and respiratory examinations were unremarkable.His admission blood tests were within normal limits. The admission electrocardiogram (ECG) showed sinus rhythm, with ST-segment elevation in an inferolateral distribution. This appeared to be an early repolarisation abnormality, with no evolving changes.His chest radiogram showed a double outline at the left heart border with subcutaneous gas collection over the left supraclavicular fossa but no evidence of pneumothorax. A computed tomography (CT) showed prominent mediastinum with gas tracking into the neck but no connection to the oesophagus or pneumothorax.He was managed conservatively and a repeat chest radiogram after 48 hours showed improvement.