Spontaneous pneumomediastinum (SPM) is a rare and benign condition predominantly seen in young males. Patients present with non-specific pleuritic chest pain, cough, and dyspnea. Hence, it is difficult to diagnose in the acute setting until other serious differential diagnoses involving the integrity of the aerodigestive tract have been excluded. This results in over investigation and overtreatment until a diagnosis has been confirmed. We report a case of a 21-year-old Omani female who presented with a complaint of cough. She was diagnosed based on clinical and radiological findings after exclusion of hollow viscous perforation to have SPM extending to the spinal canal (pneumorrhachis). Her condition improved following conservative management, and she was sent home after three days.