Pneumothorax and pneumomediastinum can occur spontaneously, secondary to trauma, or from dissection of air from the neck or retroperitoneal space. The most common cause of traumatic pneumomediastinum is a rupture of the esophagus, which can occur during an episode of severe vomiting or, less frequently, following esophageal instrumention. We experienced a case of pneumothorax and pneumomediastinum, developed after esophageal perforation by stylet during difficult endotracheal intubation even though an esophagogram did not reveal the perforation site.