Spontaneous pneumomediastinum is a rare occurrence in patients on mechanical ventilation. It usually occurs as a complication of endotracheal intubation, causing a defect in the membranous posterior wall of the trachea. Rarely, a defect in the anterolateral tracheal wall results in pneumomediastinum. The most likely pathophysiology resulting in weakening of the anterior fibrocartilaginous trachea is reduction in the vascular supply causing ischaemia. We report here a case of pneumomediastinum in a patient with myasthenia gravis on mechanical ventilation due to an anterior tracheal wall defect, which possibly resulted from ischaemia of the tracheal wall secondary to steroid use or previous prolonged endotracheal intubation.
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