Aim of the study was to analyze the course of coronavirus pneumonia in patients with pneumomediastinum. Material and methods. The study included 139 patients, 71 of whom developed spontaneous pneumomediastinum against the background of coronavirus pneumonia. Laboratory, clinical and radiological data were analyzed and compared. Results. The relationship between the severity of viral pneumonia (3rd–4th degree of severity according to MSCT) and pneumomediastinum was revealed. It was found that spontaneous mediastinal emphysema in patients with COVID-19 signifcantly more often leads to the development of acute respiratory distress syndrome, multiple organ failure and can be a predictor of negative prognosis of the disease outcome. Conclusions. Pneumomediastinum in patients with viral pneumonia caused by a new coronavirus infection is a predictor of severe disease and poor prognosis. With an increase in spontaneous mediastinal emphysema without pneumothorax, it is recommended to perform mediastinotomy according to Razumovsky’s indications, and in case of clinically signifcant concomitant pneumothorax – drainage and revision of the mediastinum.