title: Acute non-traumatic gastrothorax: presentation of a case with chest pain and atypical radiologic findings.
abstract: A previously well 71-year-old woman presented to the Emergency Department with acute-onset left-sided chest pain. She was haemodynamically stable with unremarkable systemic examination. Her electrocardiogram and troponin were within normal limits and her chest radiograph showed a raised left hemi-diaphragm. Two hours after admission, this woman became acutely breathless, and suffered a pulseless electrical activity cardiac arrest. After cardiopulmonary resuscitation, there was a return of spontaneous circulation and regained consciousness. A repeat clinical assessment revealed a new left-sided dullness to percussion with contralateral percussive resonance on respiratory examination. CXR revealed a left pan-hemi-thoracic opacity whilst better definition using CT-pulmonary angiography (CTPA) indicated an acute tension gastrothorax secondary to a large left-sided diaphragmatic hernia. Nasogastric (NG) tube insertion was used to decompress the stomach and the patient underwent uncomplicated emergency laparoscopic hernia reduction. She remained well at 1-year follow-up.
authors.affiliation: West Suffolk Hospital, Suffolk, United Kingdom. Address: West Suffolk Hospital, Hardwick Lane, Bury Saint Edmunds, Suffolk IP33 2QZ, United Kingdom. Email: singhrheumatology@gmail.com.
authors.forename: Deepwant
authors.initials: D
authors.lastname: Singh
authors.affiliation: Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, United Kingdom.
authors.forename: Pieter
authors.initials: P
authors.lastname: Mackeith
authors.affiliation: Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, United Kingdom.
authors.forename: Dipesh Pravin
authors.initials: DP
authors.lastname: Gopal
mesh_terms: D000208:Acute Disease; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002637:Chest Pain / Q000209:etiology; D000072226:Computed Tomography Angiography; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007441:Intubation, Gastrointestinal; D010535:Laparoscopy / Q000379:methods*; D013272:Stomach Diseases / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology
keywords: cardiopulmonary arrest; diaphragmatic hernia; laparoscopic surgery