Tension gastrothorax: a rare cause of breathlessness
- Correspondence to Dr James William Gagg, Emergency Department, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton TA1 5DA, 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.
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.
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.