This patient initially presented with Status Asthmaticus. Despite aggressive medical management, her condition failed to improve and she was intubated for mechanical ventilation. While on the ventilator, the patient developed significant auto-PEEP (PEEP – positive end expiratory pressure or pressure remaining in the lungs after an exhalation) as a result of air trapping. This lead to barotrauma with a left sided pneumothorax and an extensive SQ emphysema (white arrow on the image above).