Pneumothorax cocaine

Non-cardiac Anemia, anxiety disorders, carbon monoxide poisoning, cocaine use, esophageal reflux, peptic ulcer, pleuritis, pneumonia, pneumothorax, pulmonary embolus, pulmonary hypertension, thyrotoxicosis... 

Two cases of spontaneous pneumothorax in intranasal cocaine users have been reported from Italy (112). 

A 30-year-old man, a cocaine sniffer, who had used cocaine more than five times a month for 4 years, complained of shortness of breath and acute chest pain. He had episodic cough and bloody sputum. A chest X-ray showed an 80% pneumothorax on the left side. On thoracoscopy the entire lung visceral pleura seemed to be covered by fibrinous exudate. After yttrium aluminium garnet (YAG) laser pleurodesis surgery, which abrades the pleura, he made a full recovery within 4 days. 

In both cases, pneumothorax occurred with a delay after cocaine inhalation. The authors suggested that it was therefore unlikely that these cases of pneumothorax were due to direct traumatic effects of the drug powder inhaled, to barotrauma due to exaggerated inspiration, or to a Valsalva maneuver. Histological examination in both cases showed small foreign body granulomas with polarized material in the subpleural parenchyma. The authors proposed that the pleural damage could have been directly caused by a filler substance known as mannite (a fine white powder comprised of insoluble cellulose fibers). 

Maeder M, Ullmer E. Pneumomediastinum and bilateral pneumothorax as a complication of cocaine smoking. Respiration 2003 70 407. 

Torre M, Barberis M. Spontaneous pneumothorax in cocaine sniffers. Am J Emerg Med 1998 16(5) 546-9. Rome LA, Lippmann ML, Dalsey WC, Taggart P, Pomerantz S. Prevalence of cocaine use and its impact on asthma exacerbation in an urban population. Chest 2000 117(5) 1324-9. 

A 24-year-old man who had been inhaling cocaine nasally 4—5 times a month for a year developed respiratory distress and chest pain 2 days after the last use, because of a right-sided pneumothorax. He underwent video-assisted thoracoscopic surgery with laser pleurodesis and responded rapidly. 

Torre M, Barberis M. Spontaneous pneumothorax in cocaine sniffers. Am J Emerg Med 1998 16(5) 546-9. 

Respiratory Cocaine use is associated with various pulmonary complications. Pneumothorax, lung cavitation, and pleural empyema have been reported [27 ]. 

Cocaine powder has a direct effect on the lungs and there is an indirect effect via vasoconstriction. Barotrauma was the most likely cause for the pneumothorax and pneumomediastinum in this case. 

Solini L, Gourgiotis S, Salemis NS, Koukis I. Bilateral pneumothorax, lung cavitations, and pleural empyema in a cocaine addict. Gen Thorac Cardiovasc Surg 2008 56 610-2. 

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