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- Catriona Macrae, Christopher Brown, Christine Aiken, and Ravi Jamdar.
- Glasgow Royal Infirmary, Glasgow, UK catrionamacrae@nhs.net.
- Clin Med (Lond). 2019 Jul 1; 19 (4): 321324321-324.
AbstractA 26-year-old male presented with a 24-hour history of pleuritic chest pain following intranasal cocaine insufflation. He was a smoker, cannabis and alcohol user. Cardiovascular and respiratory examinations were unremarkable.His admission blood tests were within normal limits. The admission electrocardiogram (ECG) showed sinus rhythm, with ST-segment elevation in an inferolateral distribution. This appeared to be an early repolarisation abnormality, with no evolving changes.His chest radiogram showed a double outline at the left heart border with subcutaneous gas collection over the left supraclavicular fossa but no evidence of pneumothorax. A computed tomography (CT) showed prominent mediastinum with gas tracking into the neck but no connection to the oesophagus or pneumothorax.He was managed conservatively and a repeat chest radiogram after 48 hours showed improvement.© Royal College of Physicians 2019. All rights reserved.
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