**Core Concept**
Pneumomediastinum refers to the presence of air or gas in the mediastinum, which is the central part of the chest cavity containing the heart, trachea, esophagus, and other vital structures. Management of pneumomediastinum requires careful consideration of the underlying cause, which can range from trivial to life-threatening conditions.

**Why the Correct Answer is Right**
The management of pneumomediastinum often involves conservative measures, such as monitoring and supportive care, especially if the patient is asymptomatic or has a minor cause. In cases where there is significant air leak or the patient is unstable, the correct answer is a more invasive approach. Needle aspiration or thoracostomy may be required in severe cases to prevent complications. The correct answer is a procedure that helps to alleviate the air leak and prevent further complications.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not address the underlying cause of pneumomediastinum. Antibiotics may be used if there is a suspicion of infection, but they do not directly manage the air leak.

**Option B:** This option is incorrect because it is a diagnostic tool, not a therapeutic intervention. Chest X-ray is used to confirm the diagnosis of pneumomediastinum, but it does not treat the condition.

**Option C:** This option is incorrect because it is a general term for managing respiratory distress, but it does not specifically address the management of pneumomediastinum.

**Clinical Pearl / High-Yield Fact**
In cases of pneumomediastinum, it is essential to identify and treat the underlying cause, such as a spontaneous pneumothorax or a traumatic injury. Early recognition and management can prevent complications and improve outcomes.

**Correct Answer:** C. Chest tube insertion or thoracostomy.