Clinical Presentation
An 18-year-old man after a motor vehicle accident.
Imaging Findings
(A, B) Contrast-enhanced computed tomography (CT) of the chest shows a mediastinal hematoma in the posterior mediastinum and paraspinal region, fracture-dislocation of the thoracic spine, and deformity of the right posterior lateral tracheal wall with pneumomediastinum (arrows).
Differential Diagnosis
• Tracheal rupture: Deformity and discontinuity of the tracheal wall with associated pneumomediastinum are consistent with tracheal rupture.
• Pneumomediastinum without tracheal rupture: In severe, blunt thoracic trauma, pneumomediastinum may develop without associated tracheobronchial or esophageal rupture.
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