A review of medical literature shows comparatively few cases of invasion of the mediastinal space by air incident to acute obstructive laryngitis. Pneumopericardium has never been so demonstrated. The following cases are therefore presented to the attention of otolaryngologists to indicate the relatively frequent occurrence of these previously held rare conditions. Although the complications in these instances were transitory and all patients recovered, the occurrence of these conditions in the field of otolaryngology was deemed sufficiently important to warrant comment.All cases studied were encountered in the routine treatment of patients admitted to the croup service of Willard Parker Hospital. Being obstructive infections of the upper part of the respiratory tract, the conditions were brought to the attention of the visiting otolaryngologists. All conditions were identified as nonspecific infectious croup; none were of diphtheritic origin. Of 20 tracheotomized patients observed during the past year, 4 have shown the presence of air in the mediastinal structures. Included in this review is 1 case in which tracheotomy was not performed.There were no distinctive features present in these cases to differentiate them from other cases under observation in which tracheotomy had been performed. Routine auscultation of the heart and lungs showed a characteristic crepitus over the precordial area, and roentgen examinations revealed the presence of air in the mediastinal tissues. This crepitus is described by Dr. Stern, resident physician of Willard Parker Hospital, as a crackling murmur at the left border of the heart, heard best on expiration and simulating the crushing of cellophane in the hand. Because of numerous rales, rhonchi and harsh breath sounds and the coughing and restlessness of these children, it is difficult to recognize this diagnostic sign. Speculation on the rather frequent appearance of this unusual complication within recent months disclosed greatly improved roentgenograms since these conditions became manifest. This improvement was effected by substantially reducing the time of exposure of each plate, thus producing clearer pictures with minimal

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