Background: Mediastinal emphysema refers to presence of air within the mediastinum while subcutaneous emphysema refers to the presence of air in the subcutaneous tissue involving face, neck or trunk. Spontaneous subcutaneous emphysema and pneumo-mediastinum are rare cases. We are presenting a case of pneumo-mediastinum and subcutaneous emphysema complicating an acute exacerbation of asthma in a young female to sensitize treating physicians of this unexpected complication. Case Report: A 20 year old female presented with acute onset shortness of breath and neck pain. She was diagnosed as exacerbation of bronchial asthma with spontaneous pneumo-mediastinum and subcutaneous emphysema. Patient underwent X-ray chest and High Resolution Computed Tomography of chest, and responded to oxygen, nebulisations and antibiotics. Conclusion: It is imperative for emergency physicians to have a high index of suspicion to diagnose this rare complication in patients presenting as acute exacerbation of bronchial asthma as starting patients on non invasive ventilation (NIV) or mechanical intubation may lead to disastrous outcomes.