Cocaine-Induced Cervical Emphysema and Pneumomediastinum

Cervical emphysema and pneumomediastinum are rare conditions, especially outside the setting of blunt trauma. Here we describe a case of a 31-year-old male with a history of cocaine use presenting with cough, odynophagia, neck pain, and neck swelling after forcefully blowing his nose to relieve cocaine-associated congestion and obstruction. Physical exam demonstrates crepitus along the neck and clavicular regions. Imaging shows cervical emphysema, pneumomediastinum, and a nasopharyngeal fistula. We discuss presentation, causes, diagnosis, and management of cervical emphysema and pneumomediastinum.