Early diagnosis and repair of tracheal rupture are necessary to prevent acute tension pneumothorax, airway obstruction, and chronic tracheal stenosis. Few reliable radiographic signs of tracheal rupture have been proposed. We diagnosed seven cases of tracheal rupture, two related to blunt trauma and five resulting from tracheal intubation. Early radiographic signs included orientation of the distal portion of the endotracheal tube to the right relative to the lumen of the trachea with an overdistended endotracheal balloon cuff, migration of the balloon toward the endotracheal tube tip, and pneumomediastinum and subcutaneous emphysema. In four cases, the overdistended balloon with distal migration preceded the pneumomediastinum by several hours. An overdistended balloon in a patient after tracheal intubation or blunt chest trauma should suggest tracheal rupture.