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

TL;DR

A 24-year-old man developed rare lung and heart air leaks after using cocaine, which resolved with conservative care.

Contribution

This case highlights cocaine-induced thoracic barotrauma as a rare but important clinical entity.

Findings

Cocaine use can cause pneumomediastinum, pneumopericardium, and pneumothorax.

Conservative management can be effective in hemodynamically stable patients.

Imaging is critical to rule out life-threatening conditions like esophageal rupture.

Abstract

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.

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