Tension gastrothorax is a life threatening condition characterized by herniation of the stomach through a defect in the diaphragm with compression of the mediastinal contents
Although many cases occur in pediatric patients (secondary to congenital defects), adults with a history of diaphragmatic injury are at risk (also patients with a type III or IV hiatal hernia)
The clinical presentation is the same as a tension pneumothorax - hypotension, tachycardia, hypoxia, JVD, and decreased breath sounds
CXR appearance can be very similar to tension pneumothorax, however, the treatment is substantially different
Needle decompression and tube thoracostomy are contraindicated, as this may cause visceral perforation
The treatment of choice is NGT (or OGT) decompression followed by surgical repair
References
Patton J, Gonzales J, Dillard TA, Szerlip HM. Chest 2008;134:872-5.
