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Emerg Med J 30:500 doi:10.1136/emermed-2012-202196
  • Images in emergency medicine

Tension gastrothorax: a rare cause of breathlessness

  1. Andrew Savva
  1. Emergency Department, Musgrove Park Hospital, Taunton, UK
  1. Correspondence to Dr James William Gagg, Emergency Department, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton TA1 5DA, UK; james.gagg{at}tst.nhs.uk
  • Received 10 December 2012
  • Accepted 11 December 2012
  • Published Online First 8 January 2013

A 67-year-old lady presented to the emergency department with a 4 day history of breathlessness for which she had started clarithromycin. She had a history of a hiatal hernia repair in 1996 and had recently started inhalers for presumed chronic obstructive pulmonary disease (COPD). Her pulse was 101 bpm, blood pressure 174/120 mm Hg, respiratory rate 36 and O2 saturations 88% on air. She was clammy, dyspnoeic and auscultation of her chest revealed global wheeze. She was treated for an exacerbation of COPD.

A chest radiograph showed a massive gastrothorax with mediastinal shift (figure 1). Attempts to pass a nasogastric tube were unsuccessful and she rapidly deteriorated, becoming drowsy, dropping her blood pressure to 108/60 mm Hg and O2 saturations to 86% on 60% O2. Some clinical improvement was seen after intubation. A CT chest was performed which demonstrated a volvulus of the stomach with mediastinal shift (figure 2). An emergency endoscopic decompression of the stomach resulted in a return of haemodynamic stability.

Figure 1

Chest radiograph demonstrating the grossly dilated stomach and mediastinal shift.

Figure 2

CT thorax showing dilated stomach and heart displaced into right hemithorax.

Tension gastrothorax is a rare life-threatening condition that needs early decompression of the stomach either by nasogastric tube, endoscopy or in extremis by needle decompression.1

Following repair of a grade IV hiatus hernia, she successfully stopped all inhalers and fully recovered.

Footnotes

  • Contributors Both myself and the co-author were actively involved in this patient's management and the subsequent writing of this article.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Reference


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