Gastrothorax or tension pneumothorax: A diagnostic dilemma

Abstract

Gastrothorax, a rare complication following thoracoabdominal aortic aneurysm repair, is reported. The clinical features of a gastrothorax and tension pneumothorax are similar and thus, a gastrothorax can masquerade as a tension pneumothorax. The diagnosis is made by a high level of clinical suspicion, chest X-ray shows a distended stomach with air fluid levels and a computerised tomography is useful in assessing the diaphragm and establishing the positions of the various intra-abdominal organs. Also, the risk of an intercostal drainage tube placement and the role of nasogastric tube in avoiding the development of a tension gastrothorax is highlighted.

Congenital pleuroperitoneal hernia presenting as gastrothorax in five cavalier King Charles spaniel dogs

“…The clinical signs were mainly respiratory distress, and gastric dilatation can also impede venous return and obstruct the major vessels, leading to obstructive shock and, ultimately, to cardiac arrest (Bambgade 2006, Zedan et al 2008, Ng et al 2013. In this case series, thoracic radiographs were sensitive in confirming this condition: tension gastrothorax is characterised by a well-defined, air-filled structure in the left hemithorax causing collapse of the ipsilateral lung; poorly defined left hemidiaphragm; and loss of intra-abdominal stomach (Singh et al 2011, Ng et al 2013 should be considered a differential diagnosis in young dogs presenting with tachypnoea and dyspnoea. Defects of the left crus of the diaphragm could predispose the stomach to herniate into the thoracic cavity, with potential resulting tension gastrothorax.…”

“… , Singh et al . ). Due to the rare nature of this condition, the occurrence and frequency are difficult to predict ( Salim & Ramesh ), but it could potentially develop every time the stomach herniates into the thoracic cavity.…”

“…In this case series, thoracic radiographs were sensitive in confirming this condition: tension gastrothorax is characterised by a well‐defined, air‐filled structure in the left hemithorax causing collapse of the ipsilateral lung; poorly defined left hemidiaphragm; and loss of intra‐abdominal stomach ( Singh et al . , Ng et al . ).…”

“…The negative intrathoracic pressure due to diaphragmatic excursion and chest wall expansion forces the stomach through the diaphragmatic defect into the thoracic cavity, and the consequent air entrapment and stomach dilatation lead to a mediastinal deviation with a possible fatal outcome (Bambgade 2006, Zedan et al 2008, Ng et al 2013. This condition is known as tension gastrothorax, and it is a rare life-threatening mechanism: the stomach can be filled with air as a result of aerophagia during respiratory distress through a one-way valve effect due to the abnormal angulation of the gastroesophageal junction and the gastric outlet obstruction at the level of the diaphragmatic defect (Horst et al 2005, Singh et al 2011. Due to the rare nature of this condition, the occurrence and frequency are difficult to predict (Salim & Ramesh 2009), but it could potentially develop every time the stomach herniates into the thoracic cavity.…”

Life threatening nontraumatic tension gastrothorax

“…Tension gastrothorax is a very rare but potentially fatal clinical condition in which the stomach that herniates through a diaphragmatic defect into the thorax is massively distended by trapped air. It leads to severe symptoms due to the compression of the lung and mediastinum . Common etiologies include congenital diaphragmatic hernia occurring in childhood or adulthood and traumatic diaphragmatic injury (blunt or penetrating trauma) .…”