Red flag; wheezing with neck pain may be a clue to the early diagnosis of spontaneous pneumomediastinum.

Spontaneous pneumomediastinum is an uncommon clinical condition in pediatric field. We report two pediatric cases with first time wheezing episode complicated by pneumomediastinum. Investigations failed to reveal any underlying cause for secondary pneumomediastinum. Pneumomediastinum most commonly occurs in asthmatic children. It can be explained by increased pressure gradient between the intraalveolar and interstitial spaces. We conclude that high prevalence of respiratory infections in children predisposes for spontaneous pneumomediastinum due to increased pressure within obstructed airways, or by tissue necrosis from parenchymal infection.