Clinical course and outcome of cocaine-induced pneumomediastinum

Abstract

Background and objectives: Cocaine inhalation has been linked to the development of pneumomediastinum. The aim of this review was to identify the clinical course and outcome of spontaneous pneumomediastinum caused by cocaine use.

Material and methods: We performed a literature search in English language using PubMed. We included all case reports and case series of spontaneous pneumomediastinum caused by cocaine use. Twenty-three case reports and 7 case series describing 40 patients were identified. In addition, 2 young adults who were admitted to our teaching hospital with cocaine-induced pneumomediastinum were included in this review.

Results: Among 42 patients, 93% were presented with chest pain and 64% had subcutaneous emphysema. Symptoms subsided after a median of 24 hours, and radiological abnormalities abated after 2 to 30 days, with a median of 4.5 days. Pneumothorax was present in 19% of patients, and only 1 required chest tube placement. Patients were discharged with full recovery after 1 to 6 days, with a median of 2 days.

Conclusion: Cocaine-induced pneumomediastinum is a benign condition. A short observation period with outpatient follow-up is appropriate in the majority of patients. Invasive procedures have a low yield and should be based on a high degree of clinical suspicion for esophageal rupture or bronchial tree laceration.