The traumatic mediastinal emphysema occurs along with severe combined injuries. A typical feature is the subcutaneous emphysema as well as crackling sounds and frequently a pneumothorax. The radiography of the chest shows air in the mediastinum surrounding the mediastinal structures. The pleura drainage could be done as an emergency performance in cases of pneumothorax. In cases of an increasing subcutaneous and mediastinal emphysema as well as circulatory failure a cervical mediastinotomy should be carried out. The tracheobronchial tree should be examined bronchoscopically for possible ruptures. Esophagus injuries will be detected by the distribution of a contrast fluid. Even a thoracotomy may be necessary.