A case of cervical and mediastinal air emphysema is reported in a 27 year old man admitted to the hospital complaining of sudden chest pain and trouble breathing (dyspnea). A chest X-ray showed emphysema in the cervicofacial, thoracic and axillary regions with no evidence of broken ribs. He had taken ecstasy at an unspecified time before the complaints arose, and used other (undisclosed) drugs, but no attempt was made to verify recent MDMA consumption through detection in bodily fluids or hair. The condition improved within a few days, with almost complete recovery noted. The authors hypothesize that air emphysema after ecstasy use arises when intense physical activity produces changes in the respiratory system, though they also indicate that air emphysema is associated with inhalational drug use. No direct pharmacological mechanism is proposed for ecstasy-related air emphysema. Similar cases have been reported after ecstasy use (find pneumostadium reference).