Figure 5.

Suspected injury of the upper thoracic oesophagus following traumatic intubation. Patient intubated and unable to swallow contrast. (a, b) Axial and sagittal chest images from a chest CT done without oral or i.v. contrast in lung windows shows sentinel pneumomediastinum (arrows) and left pneumothorax. Since this could emanate from either a tracheal or oesophageal injury, endoscopy was done and confirmed injury to the upper thoracic oesophagus. Teaching point: this case highlights the value of doing a non-contrast CT for detection of subtle pneumomediastinum, confirming suspicion of oesophageal injury. Often the patients’ clinical condition may preclude transfer to the fluoroscopic suite and administration of oral contrast.