title: [Tension gastrothorax as a cause of death by obstructive shock - case report].
abstract: BACKGROUND
  Tension gastrothorax is caused by the herniation of the stomach into the thorax due to a congenital defect of the diaphragm; the Bochdaleck diaphragmatic hernia (HDB) is the most frequent type.
  
  
  OBJECTIVE
  Tension gastrothorax should be considered as a differential diagnosis in patients with obstructive shock and tension pneumothorax.
  
  
  METHODS
  A previously healthy 10 month-old male infant, who presented increased respiratory distress, increased volume of the left hemithorax, absence of breath sounds, ipsilateral hyper-resonance, 76% saturation, cold skin and capillary filling > 5 seconds, followed by a cardio-respiratory arrest. Due to clinical suspicion of pneumothorax, needle decompression was performed reversing cardiac arrest, but with persistent hemodynamic and respiratory instability; chest radiograph suggested diaphragmatic hernia. He underwent surgery confirming the presence of a diaphragmatic hernia of 5 cm.
  
  
  CONCLUSIONS
  The evolution of this case shows the difficulty differentiating a tension gastrothorax from tension pneumothorax in patients admitted to the emergency room who are in serious condition; therefore, a high index of suspicion is needed for its identification.
authors.forename: Juan F
authors.initials: JF
authors.lastname: García-Regalado
authors.forename: Mariana M
authors.initials: MM
authors.lastname: Navarro-Rojas
mesh_terms: D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006323:Heart Arrest / Q000209:etiology; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D008297:Male; D011030:Pneumothorax / Q000175:diagnosis*; D011859:Radiography; D012131:Respiratory Insufficiency / Q000209:etiology; D012769:Shock / Q000209:etiology*