Pneumothorax in pregnancy associated with cocaine use

Pneumothorax is extremely rare during pregnancy. We describe two antepartum cases temporally associated with cocaine use with a review of the literature and discussion on treatment options. Case 1, a 39-year-old female, presented at 31.3 weeks' gestation with a right pneumothorax after smoking crack cocaine. The pneumothorax was refractory to conservative therapy necessitating transaxillary resection of apical lung blebs. Fetal compromise was diagnosed at 34.6 weeks of gestation requiring induction of labor and subsequent delivery of a viable infant. Case 2, a 27-year-old female, presented at 28.9 weeks of pregnancy with her third episode of recurrent left pneumothorax. Thoracotomy and excision of lung bleb was performed and the patient was discharged on postoperative Day 5. Although the patient denied any history of drug use, drug screens were positive for cocaine. The patient delivered at term without further complications. Cocaine use is a predisposing factor for pneumothorax during pregnancy. Spontaneous pneumothorax carries a high risk of recurrence, possibly higher if induced by continued cocaine use. Surgical intervention should be considered in refractory or recurrent cases.