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Brenner tumors are rare ovarian neoplasms composed of ovarian transition cells surrounded by dense fibrous tissue. Most of them are small tumors (<2 cm), detected incidentally in asymptomatic women. Its predominantly fibrous content results in relatively low signal on T 2 weighted images, establishing differential diagnosis with ovarian fibroma and thecoma. Their imaging features are very similar, the differentiation is based on secondary characteristics, such as signs or symptoms of estrogen excess and the presence of a second ovarian neoplasm, which has been reported in up to 30% of patients with Brenner tumor. Although originally thought to be universally benign, there have been scattered reports in the past decades of borderline and malignant forms of Brenner tumors.

Competing Interests: The authors have no conflicts of interest to declare. Moreover, they are aware that the manuscript's copyright belongs to GE Portuguese Journal of Gastroenterology

Pneumomediastinum is more frequent in young men and usually presents in association with subcutaneous emphysema. It can occur in case of oesophageal or chest trauma, be iatrogenic or develop spontaneously, in case of emesis, coughing or forceful straining. Use of illicit drugs, such as cocaine, has been associated with multiple respiratory complications, including pneumomediastinum and subcutaneous emphysema. The pathogenesis of subcutaneous emphysema and pneumomediastinum after cocaine inhalation is not completely known, but it is thought that the physical manoeuvers used to increase its absorption and effect may lead to alveolar rupture, resulting in air escaping into the mediastinum and fascial planes of the neck and chest. Chest X-ray is usually diagnostic, but CT can be used as complementary study, allowing evaluation of adjacent structures. A case of pneumomediastinum and subcutaneous emphysema after cocaine inhalation in an otherwise healthy man is presented., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)