Pneumomediastinum in a smoking free-base cocaine abuser during sexual intercourse

Clinical history: There were no pathologies in family history. He did not take any medications. He was smoking 10 cigarettes daily. He was a habitual cocaine user. The patient had a blood pressure of 120/80 mmHg, a resting heart rate of 73 beats/minute, a respiratory rate of 16 breaths/minute, an oxygen saturation of 98%, and no temperature. The main symptom was an initial sharp retrosternal chest pain starting 5 hours before in the course of free-base cocaine smoking. Dyspnea and retrosternal pain were increasing with breath and chest movements. The pain was intensifying 2 hours earlier during sexual intercourse with a female partner. Then, the retrosternal pain was constant as regards intensity and localization. Subcutaneous emphysema of the neck was palpable on physical examination. Inspiratory effort and elicited rib pain was evident on chest examination. Cardiopulmonary auscultation and electrocardiography were normal.