To the Editor: Although pneumomediastinum may occur spontaneously without any apparent precipitating cause,1,2 it has been associated with a wide variety of conditions.2 3 4 We describe a case occurring during motorcycling. A 28-year-old man was riding his motorcycle at 160 km (100 miles) per hour without a helmet and with his mouth open, when he noticed a popping sensation in his neck. This was rapidly followed by neck and chest discomfort, worsened by movement; he was evaluated in the emergency room. His medical history was unremarkable, and he was a nonsmoker. On examination he was in mild distress with stable vital.
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