Symptoms of acute TBI usually include tachypnea, dyspnea, and, occasionally, hemoptysis. Subcutaneous emphysema, pneumothorax, and/or pneumomediastinum are common, and these will frequently be seen on chest radiograph or CT scan. Rib fractures are also common, and, historically, those involving any of the first three ribs are present in up to 90% of patients with TBI. Although the chest radiograph may be unremarkable in up to 20% of patients, rarely a “fallen lung” sign is observed. This refers to a peripheral displacement of the collapsed lung after a complete bronchial rupture results in an inability of the still-attached vascular structures to support the lung in its usual position. Occasionally, the diagnosis of TBI is suggested by a persistent and massive air leak after chest tube thoracostomy for pneumothorax. Early complications of TBI include pneumothorax, pneumomediastinum, respiratory failure, lung torsion, mediastinitis, empyema, and death.