Tension Gastrothorax: A Diagnostic Dilemma. A Case Series of 2 Patients

Background: Tension gastrothorax describes a rare, life-threatening condition caused by stomach herniating into the thoraxthrough a diaphragmatic defect with massive distension of stomach by trapped air. It is often misinterpreted as tensionpneumothorax leading to incorrect management with increased morbidity and mortality. Careful interpretation of the chestradiograph is essential for the correct diagnosis and CT scan of the thorax which will precisely visualize all herniatedstructures. The authors present 2 cases of tension gastrothorax and discuss their imaging features and treatment outcome.Case Reports: A male patient, aged 40 yrs, presented to EMD with complaints of acute progessive respiratory distress afterhe went for swimming. The diagnosis of tension gastrothorax was suspected on chest radiograph and confirmed by passing aNasogastric tube leading into the stomach which had herniated into the left chest. The nasogastric tube decompressed thestomach, thereby causing complete resolution of respiratory distress symptoms. Patient underwent repair of diaphragmaticdefect when his condition was stable. Follow up chest radiograph showed stomach in normal position in the abdomen withno recurrence of symtoms.In another case, a male patient aged 53 yrs presented with haematemesis to EMD, Chest radiograph showed featuressuspicious of diaphramatic hernia /eventration. A diagnosis of acute diaphramatic rupture/ diaphramatic hernia was madeCECT with oral contrast. Insertion of Nasogastric tube resulted in partial reduction in the size of distended stomach. Laterpatient succumbed to hematemesis which was secondary to cirrhosis and collaterals.Conclusion: Tension gastrothorax is a life-threatening condition leading to acute and severe respiratory distress. Thecondition exhibits distinct radiographic features. Emergency decompression of the distended stomach by Nasogastric tubeshould be attempted followed by surgical repair of diaphramatic defect when the patient is stable.