We report on the case of a 15-year-old female who developed a pneumomediastinum after heavy vomiting. A rupture of the esophagus (Boerhaave syndrome) was excluded. In the CT of the chest, air was detected in the mediastinum and in the epidural space (epidural pneumatosis). The patient recovered uneventfully with conservative treatment. Air in the epidural space, associated with spontaneous pneumomediastinum, is an extremely rare condition. The air in the spinal canal arrives by migration through the intervertebral foramina from the posterior mediastinum and neck, where the fascial barrier is missing. Therapy consists of symptomatic, conservative treatment.
