[Pneumopericardium and pneumomediastinum in a diabetic and cocaine user patient].

Pneumopericardium and pneumomediastinum are uncommon and potentially serious conditions. In adults, most cases are iatrogenic in origin, caused by surgical or endoscopic procedures, or mechanical ventilation. A case related to coronary angioplasty has even been reported. Chest trauma, both open and closed, is another common cause. They have also been reported in connection with other less common conditions such as gastric or esophageal perforation with the formation of pericardiac fistulas, asthma attack, pneumonia, diabetic ketoacidosis, and cocaine use. Some spontaneous cases have also been reported. We report the case of a 23-year-old male patient with type 1 diabetes mellitus starting three years before with no chronic complications and poor metabolic control (glycosylated hemoglobin, 8.5%). The patient smoked one pack of cigarettes daily and was a habitual cocaine user. He attended the emergency room for vomiting over the previous 24 h. The patient reported no chest pain or dyspnea. A physical examination revealed a dehydrated patient with a heart rate of 100 bpm and blood pressure values of 100/60mmHg. Cardiopulmonary auscultation was normal. Laboratory test findings included metabolic acidosis with venous pH of 6.98, plasma glucose of 671mg/dL, and positive urinary ketones consistent with diabetic ketoacidosis. A urine drug screen was positive for cocaine. An electrocardiogram showed no findings of interest. Chest X-rays showed a left paracardiac radiolucent band and air levels in the mediastinum and subcutaneous cell tissue in the neck. Based on these findings, a computed tomography scan (CT) was performed, which confirmed the presence of air in the mediastinal space and anterior pneumopericardium and ruled out disease in the lung parenchyma (Figs. 1 and 2). An echocardiogram ruled out the presence of cardiac tamponade. Treatment