27歲女性糖尿病酮酸中毒出現氣縱膈併發症，這併發症很少見，此併發症不須特別處理，只要治療糖尿病酮酸中毒即可。造成氣縱膈的可能原因，酮酸中毒病人會發生嘔吐或庫氏呼吸(Kussmaul's respiration) ，此會增加肺泡內壓力，使得空氣可剝離肺泡血管周圍鞘進入縱隔腔內。主要鑑別診斷是食道破裂，可以做食道顯影或內視鏡即可排除。嚴重持續嘔吐且胸痛可能是食道破裂(Boerhaave syndrome) ;幸好，所有報導酮酸中毒引起氣縱膈的病人當中，尚未有任何人發生食道破裂的報告。

A 27-year-old female presented with pneumomediastinum complicating diabetic ketoacidosis (DKA); this complication is rare, and does not require specific treatment except DKA management. The causes of pneumomediastinum in DKA patients may be a result of vomiting or Kussmaul's respiration, where increased intra-alveolar pressure permits air to dissect along the perivascular sheath into the mediastinum. The major differential diagnosis is esophageal rupture, which can be excluded by an esophageal contrast study or endoscopy. Severe persistent vomiting and chest pain suggests esophageal rupture (Boerhaave syndrome); however, esophageal rupture has not been detected in any of the reported cases of ketoacidosis-associated pneumomediastinum.