Pneumomediastinum after cocaine smoking.

We have reported two cases of pneumomediastinum occurring in previously healthy young men after smoking cocaine and performing the Valsalva maneuver to intensify the euphoria. Pneumomediastinum is thought to result from increased intrathoracic pressure produced by the Valsalva maneuver, with resultant rupture of marginal alveoli. With the increasing popularity of inhaling free-base cocaine, physicians should be aware of this complication.