Images in Clinical Medicine

Gastrothorax Simulating Acute Tension Pneumothorax

Cornelis P.C. de Jager, M.D., and Ronald J. Trof, M.D.

N Engl J Med 2004; 351:e5August 5, 2004

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A 27-year-old man was admitted to the emergency department because of respiratory failure. Three years earlier, he had undergone surgery to repair a traumatic rupture of the left side of the diaphragm. On admission, the patient had severe respiratory distress, hypotension (blood pressure, 60/40 mm Hg), and sinus tachycardia (heart rate, 140 beats per minute). There was a rightward deviation of the trachea and distention of the neck veins. On examination, the left hemithorax was hyperresonant and without breath sounds. Heart sounds and normal breath sounds were heard to the right of the sternum. In view of the patient's history, a chest radiograph was obtained (Panel A) before thoracentesis was performed. The radiograph showed massive intrathoracic gastric dilatation with a rightward shift of the mediastinum. A nasogastric tube was immediately placed, and large amounts of gas and fluid were drained. Dramatic clinical and radiographic improvement was noted by the following day (Panel B). A few days later, the patient underwent a second operation to repair the recurrent left-sided diaphragmatic rupture and had no further complications.

Cornelis P.C. de Jager, M.D.
VU Medical Center, 1007 MB Amsterdam, the Netherlands

Ronald J. Trof, M.D.
Medical Spectrum Twente, 7500 KA Enschede, the Netherlands

Citing Articles (3)

Citing Articles

1. 1

   Gordon Fuller, Shas Čačala, George Oosthuizen. (2010) Tension Gastrothorax-Colothorax Secondary to Traumatic Diaphragmatic Hernia. Pediatric Emergency Care 26:4, 299-301
   CrossRef

2. 2

   Daniel Nishijima, Shariar Zehbtachi, Reinaldo B. Austin. (2007) Acute posttraumatic tension gastrothorax mimicking acute tension pneumothorax. The American Journal of Emergency Medicine 25:6, 734.e5-734.e6
   CrossRef

3. 3

   Nevin Kollannoor Chinnan, Ajay Rathore, Ashraf Ibrahim Mohamed Shabaan, Wael Al Samman. (2007) The “forbidden” chest x-ray: tension pyopneumothorax. The American Journal of Emergency Medicine 25:2, 200-201
   CrossRef