Severe pulmonary air-leakage associated with bi-level positive airway pressure

The discovery of a severe pulmonary airleakage (PAL) associated with bi-level positive airway pressure (BiPAP) is a truly strange clinical finding, even for a very experienced specialist in pulmonary medicine. We present a woman who developed pneumomediastinum, pneumoperitoneum, retropneumoperitoneum and subcutaneous emphysema while being treated with BiPAP for hypoxic respiratory failure associated with pneumonia. The pulmonary barotrauma completely resolved after discontinuation of BiPAP. PAL following spontaneous BiPAP is benign and self-limited.