Dear Editor, Considering the article published by Hü, lya Dirol and Hakan Keskin: Risk factors for mediastinitis and mortality in Pneumomediastinum, 1 I would like to respectfully give my opinion on the so-called spontaneous pneumomediastinum. We agree in dividing pneumomediastinum into primary and secondary, but we consider that the primary is the truly spontaneous or idiopathic, terms that should be omitted and called primary. This pneumomediastinum cannot have any predisposing or precipitating factor. The secondary, can in turn be traumatic and non-traumatic, and the latter is where the predisposing and precipitating factors influence (Figure 1). . .