Spontaneous pneumomediastinum (SPM) is a relatively uncommon occurrence. Although unlikely, asthma exacerbations can produce enough barotrauma to produce this complication. In cases of SPM, the gas has the opportunity to track between fascial planes, making its way to subcutaneous tissues, usually of the neck and chest, resulting in subcutaneous emphysema (SE). In anomalous situations, this gas can track its way into the retropharyngeal space. This presentation is usually self-limiting, requiring supportive therapy. Severe cases can lead to airway compromise warranting invasive supportive airway maneuvers. Retropharyngeal emphysema, SE, and pneumomediastinum have rarely been described together in the literature. This case provides awareness of these three complications of asthma, while highlighting the need for deliberate chest imaging, including radiograph and non-contrast CT, in patients with severe asthma exacerbations.

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