This patient with bilateral tonsillitis with bilateral tonsillar/peritonsillar abscesses was diagnosed with pneumomediastinum and cervical subcutaneous emphysema. These findings could be related to actions that increase pressure in the airway/lungs, such as violent coughing or vomiting, or Valsalva maneuver. These findings prompted an esophagram, from which the esophagus was found to be intact and without perforation. No definitive cause was found, though the most likely cause was thought to be benign pneumomediastinum secondary to coughing.