Air in the epidural space is called pneumorachis. The usual mechanism of pneumorachis is air diffusion from the mediastinal tissue layers through the inter-vertebral foramen. Alternatively, air can diffuse directly after spine
traumas (e.g., blunt deceleration with vertebral dislocation) or medical procedures. Several mechanisms could explain
pneumomediastinum and pneumorachis after
cocaine sniffing. Passive
apnea and/or
cough that occur after sniffing can cause intra alveolar hyper-pressure, which is responsible for alveolar
rupture and air diffusion. Another mechanism is alveolar wall fragility and
rupture induced by repeated
cocaine sniffing, in turn causing air diffusion to the mediastinum, sub-cutaneous tissues and the epidural space. The diagnosis is usually made on Chest tomography scan. Management consists in close monitoring in the intensive care unit to detect aggravation of
pneumomediastinum and pneumorachis, which would require surgical management. Supplemental nasal
oxygen can be given to accelerate
nitrogen washout. We present a case of a 28 years old male who presented to the emergency department for
chest pain directly after sniffing
cocaine. A computed tomography scan of the chest showed
pneumomediastinum, pneumorachis and sub-cutaneous
emphysema. The patient was admitted for 24 h: after that delay, surveillance chest tomodensitometry showed stability, and he could be discharged without further treatment.