Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 3 2022 11 02 148 157 Yu Peng Tan Department of Medicine, Hospital Ampang, Jalan Mewah Utara, Pandan Mewah,Selangor Darul Ehsan, Malaysia. Vivek Vijayan Department of Medicine, Hospital Ampang, Jalan Mewah Utara, Pandan Mewah,Selangor Darul Ehsan, Malaysia. Koon Ket Sia Department of Medicine, Hospital Ampang, Jalan Mewah Utara, Pandan Mewah,Selangor Darul Ehsan, Malaysia. 2021 07 23 2022 01 16 Spontaneous pneumomediastinum has been reported in association with COVID-19. Pneumomediastinum could remain elusive until computed tomogra- phy is performed. Hence, we need to be vigilant even though it generally has a benign clinical course. We presented four confirmed COVID-19 cases with typical ground glass opacity on chest radiograph. All four had the computed tomography that re- vealed pneumomediastinum, pneumothorax and subcutaneous emphysema. Only one patient had pneumomediastinum after intubation. Pneumomediastinum is a devastating finding which should be picked up as early as possible and must be excluded in COVID patients whom deteriorate quickly, as adequate time may pass before any viable intervention can be done to expedite the patients’ recovery. https://crcp.tums.ac.ir/index.php/crcp/article/view/576