UMEM Educational Pearls


Patient presents with chest pain after smoking crack cocaine; what's the diagnosis? 


Pneumomediastinum secondary to crack cocaine inhalation

Causes of Pneumomediastinum

  • Tracheal or bronchial perforation (e.g., trauma s/p bronchoscopy)
  • Mediastinitis (e.g., rapidly descending dental infections)
  • Esophageal perforation (e.g., Boerhaave syndrome or post-endoscopy)
  • Mediastinal trauma (e.g., stab wound to chest)
  • Rupture of lung parenchyma
    • Ruptured bleb (e.g., COPD exacerbation)
    • Valsalva maneuver (e.g., smoking illicit substances or childbirth)
    • Barotrauma (e.g., mechanical ventilation or severe asthma exacerbation)
    • Scuba Diving



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