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There is distraction at T1-T2 by distance of at least half of a vertebral body height. The T1 vertebral body is fractured posteriorly and inferiorly and there is a retropulsed fragment. There is air tracking up the epidural space to at least the level of C3-C4 and there is also dense epidural venous contrast. This appears continuous with the mediastinal air. A nasogastric tube and endotracheal tube are in place. An esophageal rupture is suspected.