Pneumothorax and pneumomediastinum occur uncommonly in association with athletic participation. Although they are rare, when they occur they can be life-threatening, requiring immediate diagnosis and treatment. These injuries also present difficult return-to-play decisions for the sports medicine physician. There are sparse data to help determine the incidence of these injuries in sport, as well as their optimal treatment. Although most sports physicians have seen these injuries, not many have seen enough to publish a large series discussing optimal management or make return-to-play recommendations.