Pneumomediastinum: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Pneumomediastinum?
A pulmonologist, a doctor who treats lung problems, or an emergency doctor often treats pneumomediastinum. Pneumomediastinum is air in the middle of the chest. A primary care doctor can help with the first evaluation and follow-up. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is pneumomediastinum?
Pneumomediastinum is air in the mediastinum. The mediastinum is the space in the middle of the chest, between the lungs and around the heart. The condition is uncommon. Another name for it is mediastinal emphysema.
Symptoms
Some people have no symptoms. The condition usually causes chest pain behind the breastbone, which may spread to the neck or arms. The pain may be worse when you take a breath or swallow.
A doctor may feel small bubbles of air under the skin of the chest, arms, or neck. This is called subcutaneous emphysema. Sometimes the person can look very puffy in the face and eyes. This can look worse than it actually is.
Causes and who gets it
Most often, pneumomediastinum happens when air leaks from the lung or airways into the mediastinum. Extra pressure in the lungs or airways can come from too much coughing, sneezing, or vomiting. It can also come from repeated bearing down, such as pushing during childbirth or a bowel movement.
It may also happen after an infection in the neck or center of the chest. Other causes include a rapid rise in altitude, scuba diving, or a tear in the esophagus (the tube from the mouth to the stomach) or the trachea (the windpipe). It may also follow use of a breathing machine (a ventilator), use of inhaled drugs such as marijuana or crack cocaine, surgery, or a chest injury. It can also occur with a collapsed lung.
How doctors diagnose it
A doctor may find the air bubbles under the skin during a physical exam. A chest X-ray or a CT scan of the chest can confirm that air is in the mediastinum. These tests can also help find a hole in the trachea or esophagus. A doctor may also hear a crunching sound that matches the heartbeat when listening to the chest.
Treatment
Often, no treatment is needed because the body slowly absorbs the air. Breathing high levels of oxygen may speed this up. A chest tube may be placed if you also have a collapsed lung. You may also need treatment for the cause of the problem. A hole in the trachea or esophagus needs to be repaired with surgery.
When to see a doctor
Call 911 or go to the emergency room if you have chest pain lasting two minutes or more, trouble breathing, or fainting. Air can build up and cause the lung to collapse. In rare cases, so much air builds up that it pushes on the heart and the great blood vessels, so they cannot work properly. These problems need urgent attention because they can be life threatening.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either kind of doctor can review your symptoms, arrange a chest X-ray, and refer you to a lung specialist when needed. Chest pain or trouble breathing needs emergency care instead.
Common questions
Is pneumomediastinum dangerous?
It can be, but not always. Some people have no symptoms, and the outlook depends on what caused it. Complications need urgent attention because they can be life threatening.
Does pneumomediastinum go away on its own?
Often it does. In many cases no treatment is needed because the body slowly absorbs the air.
What causes pneumomediastinum?
Most often, air leaks from the lung or airways into the mediastinum. Too much coughing, sneezing, or vomiting can raise the pressure in the lungs and airways.
Can scuba diving cause pneumomediastinum?
Yes, it may happen after scuba diving. It may also happen after a rapid rise in altitude.
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Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
