A 45-year-old man had a C4-C7 burst fracture while swimming. After he underwent laminectomy with C4-6 fusion, he had acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation. Because of clinical suspicion of a pulmonary embolism, a computed tomography scan was obtained, and although it did not demonstrate a pulmonary embolism, it did show the extent of his suspected barotrauma. In addition to a pneumothorax and pneumomediastinum, the black lines within the lung parenchyma indicated pulmonary interstitial emphysema (arrows in Fig 1). Discussion