Objective To analyze the characteristics of spontaneous mediastinal emphysema in people living in plateau and plain areas, explore the pathogenesis and provide treatment strategies. Method The characteristics of patients with spontaneous mediastinal emphysema in the past 3 years were retrospectively analyzed in 25 cases in Shannan City and 35 cases of Wuhu City. Compare the patient's basic information, symptoms and signs, auxiliary examinations, treatment strategy process, disease course development and prognosis, etc. Result Spontaneous mediastinal emphysema is more common in adolescents. The prevalence in plateau areas is higher than that in plain areas, and the incidence of symptoms and signs such as chest tightness, dyspnea, and subcutaneous emphysema is higher than in plain areas. In addition, the symptoms in the plateau area lasted longer, and the hospitalization period was longer. Conclusion Plateau areas, hypoxic environment, and dry climate may be the predisposing factors of spontaneous mediastinal emphysema. By comparing the characteristics of cases in the two places, we can more deeply understand the occurrence, development and course changes of spontaneous mediastinal emphysema. Finally, a safe, reliable and process-based treatment strategy for spontaneous mediastinal emphysema is provided.