A 21-year-old man presented with pleuritic substernal chest pain of one hour's duration. The pain was exacerbated in a supine position and did not radiate. He denied fever, cough, vomiting, or palpitations. No history of blunt or penetrating trauma was obtained. Further questioning revealed that he was a recreational user of cocaine and had inhaled free-based cocaine via a pipe the previous evening and as recently as two hours before admission to the hospital.Physical examination demonstrated an anxious young man with a respiratory rate of 26 breaths per minute and shallow. He was afebrile with normal heart rate and blood pressure. His sternum was tender to palpation, and auscultation revealed precordial crepitus synchronous with systole (Hamman's sign1). The remainder of the physical examination showed no abnormality.His electrocardiogram showed sinus rhythm at a rate of 62 beats per minute. Posteroanterior and lateral roentgenograms of the chest were
Wiener MD, Putman CE. Pain in the Chest in a User of Cocaine. JAMA. 1987;258(15):2087–2088. doi:10.1001/jama.1987.03400150079033
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