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A 40-year-old female had right-sided pneumothorax. She was treated with a chest tube. On the 2nd day, her menstruation started. Because of a persistent air leak, she underwent a thoracoscopic operation on the 15th day. During the operation, we noted a pulmonary bulla at the apex and multiple blue berry spots both on the visceral pleura and the tendinous part of the diaphragm. We performed a resection of the pulmonary bulla, partial diaphragmatic excision plus suture. Section of visceral pleura and diaphragm shows ductal structures, which is insistent with endometriosis. The serum CA125 level decreased to 39 U/ml. Following surgery, oral contraceptives was started and no recurrence was encountered thereafter.

We report 6 cases of spontaneous pneumomediastinum. It is defined not to have clear etiology such as trauma, and is comparatively rare disease developing suddenly. Our patients complained of chest or neck pain, dyspnea and pain when swallowing. They were 3 men and 3 women, who were young and did not have causal disease. Chest X-ray films and computed tomography (CT) scans revealed pneumomediastinum. All of them were treated conservatively and recovered completely within 10 days hospitalization. Spontaneous pneumomediastinum is uncommon and usually benign. Most patients require only conservative treatment. However, since it possibly develops tension pneumothorax, pneumothorax, or mediastinitis, careful observation is recommended never to overlook life-threatening condition. In addition, it is important to distinguish from Boerhaave syndrome, tracheal trauma and so on.