<prompt> A young male met with a road traffic accident and came to the emergency department, he was evaluated found to have BP-13080 mm HG, pulse rate - 88min, RR -22min. On auscultation there was decreased air entry on one side with absent breath sounds. X-ray chest is given below. Your most probable diagnosis isTension pneumothoraxRupture of esophagus and compressing the pericardiumFlail chest due to fracture of ribs 5,6,7,8 ribsNormal CXR  <response>: Ans. b Rupture of esophagus and compressing the pericardium This image shows Pneumo mediastinum which is a feature of Esophageal rupture. Decreased air entry implies collection of esophageal contents and pleural effusion on that side. Naclerios V sign- Presence of V shaped Gas shadow near Cardiophrenic angle on left side in Boerhaave syndrome Esophagus rupture. Macklers triad- Vomiting, Chest pain and Subcutaneous emphysema in Barotrauma Esophagus. 