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Image: pneumomediastinum following sternutation after cocaine insufflation
  1. Siu Li Boo,
  2. Fatemeh Rafati,
  3. Mark Pucci
  1. Department of Acute Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Mark Pucci, University Hospital Birmingham, Birmingham B15 2TH, UK; mark.pucci{at}

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A 31-year-old man, with no significant medical history, developed sudden onset central chest pain radiating across the upper chest wall and into the neck following sternutation (sneezing). There had been a preceding history of cocaine abuse by insufflation. On clinical examination, there was ulcerated nasal septum, palpable crepitus in the supraclavicular fossae, normal heart sounds and equal air entry to both lungs on auscultation.

His chest radiograph demonstrated bilateral supraclavicular surgical emphysema and pneumomediastinum (figure 1 …

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  • SLB and MP contributed equally.

  • Contributors SLB wrote the original article. MP and FR made the revisions to the article. All authors have made substantial contributions to the article conception. All authors give final approval of the version to be submitted and any revised version. Each author has participated sufficiently in the work to take public responsibility for appropriate portions of the content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.