CTICasesIatrogenic Gastrothorax
Imaging findings
Chest radiographs demonstrate a large, gas-filled, contained structure in the left hemithorax causing rightward mediastinal shift. A pigtail catheter is seen incorrectly placed in the pleural space, followed by a larger chest tube. An enteric feeding tube is visualized coursing into the left chest, confirming that the gas-filled structure is the stomach.
Key takeaways
An unrecognized diaphragmatic injury during surgery (such as hiatal hernia repair) can lead to acute herniation of the stomach into the thoracic cavity (gastrothorax). This can easily be mistaken for a pneumothorax by non-radiologists, leading to the dangerous misplacement of chest tubes into or adjacent to the stomach. Careful review of enteric tube paths and the outline of the gastric wall can prevent this serious diagnostic pitfall.
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