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Multiple bilateral rib fractures seen laterally and right subcutaneous emphysema including gas tracking in the right pectoralis muscle. Bilateral intercostal catheters have been inserted. The patient is intubated with the endotracheal tube tip almost at the level of the carina. This should be pulled back a few centimetres for ideal positioning. While the superior mediastinum appears widened and the aortic knuckle is poorly seen this does not necessarily imply mediastinal haematoma as the patient is supine and significantly rotated. There is however the suggestion of left apical pleural capping which can be a feature of aortic injury. Subsequent CT revealed a normal mediastinum and small volume extra-pleural haematoma at the lung apices due to first rib fractures.