Sanja Sakan1, MD, Nikolina Bašić-Jukić2, prof, Ivana Jurić2, MD, Ranka Štern-Padovan3, prof, Željko Kaštelan4, prof, Mladen Perić1, prof 1Department of Anesthesiology, Reanimatology and Intensive care, University Hospital Center Zagreb, Zagreb, Croatia (Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, Klinički bolnički centar Zagreb) 2Department of Nephrology, Arterial hypertension and Dialysis, University Hospital Center Zagreb, Zagreb, Croatia (Klinika za unutarnje bolesti, Zavod za nefrologiju, arterijsku hipertenziju i dijalizu, Klinički bolnički centar Zagreb) 3Department of Radiology, University Hospital Center Zagreb, Zagreb, Croatia ( Klinika za radiologiju, Klinički bolnički centar Zagreb) 4Department of Urology, University Hospital Center Zagreb, Zagreb, Croatia ( Klinika za urologiju, Klinički bolnički centar Zagreb) Abstract Aim: Spontaneous pneumomediastinum and subcutaneous emphysema are not frequent and well recognized complications in patients who suffer form end-stage renal disease. Case presentation: We describe an unusual case of spontaneous pneumomediastinum and extensive subcutaneous emphysema in an older patient sixteen days after cadaveric kidney transplantation due to end-stage renal disease caused by long-term diabetic nephropathy. Our patient did not have any positive medical history of pulmonary disorders or disease. Results: However we concluded that the principal mechanism was spontaneous alveolar rupture. It was the result of multifactorial etiology. Conclusion: Specific and vulnerable postransplantation period, exposure to many drugs with serious side effects together with many comorbidites of uremic patients contributed this rare, benign and self-limited complication in our case.