Air in the spinal canal after trauma is uncommon. We report a case of a motor vehicle accident resulting in a thoracic fracture-dislocation. Air was discovered within the spinal canal on a computed tomography (CT) scan. This injury pattern proved to be a diagnostic dilemma because multiple etiologies existed. Pneumothorax, ruptured esophagus, facial sinus fractures, and herniated vertebral discs can result in this entity. (c) 2006 Elsevier Inc.