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Case Reports in Emergency Medicine
Volume 2015, Article ID 134816, 3 pages
Case Report

Subcutaneous Emphysema, Pneumomediastinum, and Pneumorrhachis after Cocaine Inhalation

1Department of Emergency Medicine, Ankara Atatürk Training and Research Hospital, Üniversiteler Mahallesi Bilkent Caddesi No. 1, Çankaya, 06800 Ankara, Turkey
2Department of Emergency Medicine, Faculty of Medicine, Yildirim Beyazit University, Üniversiteler Mahallesi Bilkent Caddesi No. 1, Çankaya, 06800 Ankara, Turkey

Received 29 April 2015; Revised 14 June 2015; Accepted 15 June 2015

Academic Editor: Ching H. Loh

Copyright © 2015 Tuğba Atmaca Temrel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. The most prominent complications of cocaine use are adverse effects in the cardiovascular and central nervous systems. Free air in the mediastinum and subcutaneous tissue may be observed less frequently, whereas free air in the spinal canal (pneumorrhachis) is a very rare complication of cocaine abuse. In this report we present a case of pneumorrhachis that developed after cocaine use. Case. A 28-year-old male patient was admitted to the emergency department with shortness of breath, chest pain, and swelling in the neck and face which started four hours after he had sniffed cocaine. On physical examination, subcutaneous crepitations were felt with palpation of the jaw, neck, and upper chest area. Diffuse subcutaneous emphysema, pneumomediastinum, and pneumorrhachis were detected in the computed tomography imaging. The patient was treated conservatively and discharged uneventfully. Discussion. Complications such as pneumothorax, pneumomediastinum, and pneumoperitoneum that are associated with cocaine use may be seen due to increased intrathoracic pressure. The air then may flow into the spinal canal resulting in pneumorrhachis. Emergency physicians should know the possible complications of cocaine use and be prepared for rare complications such as pneumorrhachis.