We report a case of 18 year old male patient with alleged history of drowning evacuated from water within 2 minutes of submersion, needed initial resuscitation and ventilator support. Chest x-ray and CT chest diagnosed him with pneumomediastinum, bilateral pneumothorax and subcutaneous emphysema. Incidence of pneumomediastinum is a rare. It is usually managed conservatively. We are considering our case to be secondary pneumomediastinum as it developed following drowning and positive pressure ventilation. Though in literature several cases allowed to be reported as spontaneous pneumomediastinum following drowning or other causes, even when a possible causative factor was identified. Good prognostic indicators in case of near drowning in the emergency include GCS>5/15, short submersion time and spontaneous respiration and cardiac activity. Though our had respiratory failure, he was managed conservatively successfully and discharged home. Presence of pneumomediastinum, pneumothorax are not poor prognostic indicators per se in case of near drowning and can be treated conservatively.