Cocaine-related subcutaneous emphysema, pneumorrhachis and pneumomediastinum: a rare clinical finding

Abstract

A young man presented with several days of dyspnoea and delirium due to cocaine use which was confirmed by urine drug screening. Imaging studies confirmed the diagnosis of subcutaneous emphysema, pneumorrhachis and pneumomediastinum. He was managed successfully with conservative therapy.Although a rare clinical finding, cocaine-related pneumomediastinum, subcutaneous emphysema and pneumorrhachis should be recognised early on presentation. This will certainly help to effectively direct the use of healthcare resources and avoid subjecting the patient to unnecessary investigations.

Figure 1

Chest X-ray demonstrating extensive subcutaneous emphysema within the supraclavicular and axillary soft tissues on day 1.

Figure 2

Coronal view of chest CT scan demonstrating air outlining the visceral and parietal pleura of the mediastinum, along with emphysematous extension into the supraclavicular soft tissues.

Figure 3

Axial image of chest CT showing pneumorrhachis and subcutaneous emphysema.

Figure 4

Chest X-ray on day 2 showing marked improvement of subcutaneous emphysema.

Figure 5

Chest X-ray on day 4 showing complete resolution of subcutaneous emphysema.