The mechanism for the air in the mediastinum is suggested as being due to rupture of marginal pulmonary alveoli, allowing the development of pulmonary interstitial emphysema. This then tracks through the fascial planes at the lung hilum, and from there into the mediastinum and neck. There was no obvious underlying lung disease in our patient, and no further investigations were indicated. His lymphocytosis may have been secondary to a coryzal illness from which he was recovering at the time; upper respiratory tract infections have been associated with this condition.4 The relatively benign course and rapid recovery shown by the patient was in keeping with the findings of others,5 and recurrence is very unusual.4We thank Dr G Terry for permission to report this case.Munsell WP. Pneumomediastinum
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