The increasing availability and use of cocaine stresses the importance that physicians are aware of the medical complications of the abuse. This case report describes a 24 year-old man who got chest pain after the snorting of 6 g of cocaine. A chest X-ray revealed a pneumomediastinum, which was confirmed by a computed tomography of the thorax. Pneumomediastinum secondary to cocaine insufflations is described as a benign condition. Adequate therapy is painkillers and observation, when life-threatening condition such as oesophageal rupture is excluded.