Late presentation of subcutaneous emphysema and pneumomediastinum following elective tonsillectomy

Subcutaneous emphysema and pneumomediastinum are rare complications following elective tonsillectomy. Although the mechanism of injury is unclear, air is thought to enter through either the buccopharyngeal mucosa during surgery or via alveolar rupture during positive pressure ventilation. Patients typically present immediately after surgery or upon anesthesia emergence. We describe a case of delayed pneumomediastinum in a 30 year-old female who presented 4 days after surgery. With only one other case described, we review the literature and remind the reader to be cognizant of this late complication.