Gastrothorax mimicking acute tension pneumothorax.

We describe a case of respiratory failure due to an acute tension gastrothorax in an elderly patient, secondary to an episode of vomiting. Initially the scout view was interpreted as a tension pneumothorax. Eventually the computed tomography (CT) of the thorax revealed a transdiaphragmatical herniation of the stomach and other visceral organs. An endoscopic desufflation procedure was performed, leading to improvement of the vital signs. Consequently, surgical repair was performed. It is important to be aware of specific radiologic signs, suggesting that the intrathoracic air collection is not caused by a pneumothorax. The initial treatment of a tension gastrothorax is nasogastric or orogastric decompression.