This 60 year old man presented with acute back pain which had developed after an episode of vomiting. CXR, left shows a small left apical pneumothorax (yellow arrow), as well as some surgical emphysema extending along the right side of the neck (white arrows). Because of the latter finding, CT was performed and showed a pneumomediastinum due to oesophageal perforation (orange arrow). The left pneumothorax is indicated by the white arrow. The patient also has some consolidation in the left lung.