To the Editor.
—We read with interest the article by Rose et al1 in the February 1984 Archives. The authors described two patients with spontaneous pneumomediastinum (SP), who initially had those symptoms. There was no underlying disease that could explain the appearance of the mediastinal emphysema. Their final conclusion is that SP should be included in the differential diagnosis in patients who complain of chest and neck pain and dysphagia.During the last four years, we have observed 16 cases of SP; 13 of them have been reported in one series.2 Eight cases (50%) had chronic asthma, and in all eight, the SP was associated with an acute exacerbation of the disease. One patient had diabetic ketoacidosis and another had pulmonary tuberculosis as associated conditions. In six cases (37.5%), no underlying disease or physical effort precipitated an elevation of the intra-alveolar pressure. Our experience and an extensive review