The authors present 7 cases with spontaneous pneumomediastinum (SPM), a rare pathological condition. The cause of SPM is rupture of marginal alveoles and spread of air into the mediastinum through perivesical and peribronchial fats. Males are more frequently affected, but females were prevalent in this study (as 4:3). At the stage when air does not spread outside the mediastinum, Hamman's sign, i.e. "crepitation" ("a crunching sound", "a noise of air bursting bubbles") heard at cardiac auscultation is significant in the diagnosis. Dissection of air in all mediastinial structures, which is detectable during X-ray studies both at this stage of SPM, and at the stage of spread of air to the neck, chest, and abdomen is an important diagnostic sign. The evolution of SPM is generally good and conservative therapy leads to recovery in most patients. In 9-16% of patients, the evolution of the process is dramatic and requires cervical mediastinotomy after Tiegel or thoracotomy with wide mediastinotomy.
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