19 years old male patient with recent ingestion of a large dose of cocaine presented with sharp chest pain radiating to neck with pressure feeling in the neck and mild hoarseness. Chest X-ray revealed extensive surgical emphysema with no pneumothorax. CT neck, chest, abdomen, and pelvis showed surgical emphysema in the neck along with pneumomediastinum and suspicion of a partial tear of the lower esophagus. Endoscopy was normal, the patient was managed conservatively with pain relief and monitoring and was discharged after three days in stable and improved condition with one week follow up which showed resolution of subcuta- neous emphysema.
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