“…The escape of air into mediastinal tissues referred to as pneumomediastinum is a serious condition most commonly attributed to ruptured pulmonary blebs. Although Macklin first reported it as caused by increased intra‐alveolar pressure due to screaming, coughing, defecation, or emesis (1), it has also been associated with DKA (4,5), marijuana use (6), and childbirth (7). Zegal and Miller described self‐induced vomiting which may lead to esophageal rupture and a particularly dangerous form of pneumomediastinum, since mediastinitis is associated.…”