Traumatic Gastrothorax Mimicking a Pulmonary Pneumatocele after Blunt Trauma: A Case Report

Abstract

Traumatic diaphragmatic rupture may be overlooked after blunt thoracoabdominal trauma, particularly when herniated abdominal viscera mimic primary thoracic disease. We report a 20-year-old man admitted after a road traffic accident. Initial computed tomography (CT) was interpreted as showing a large left pulmonary air-fluid cavity consistent with traumatic haematopneumatocele. During observation, tachycardia, tachypnoea, and oxygen desaturation developed. Radiological reassessment demonstrated a large left diaphragmatic discontinuity with intrathoracic herniation of the stomach and colon, pulmonary compression, and rightward mediastinal displacement. Retrospective review of the initial CT showed continuity between the thoracic air-fluid structure and the stomach. Emergency laparotomy revealed an approximately 5-cm diaphragmatic defect containing the stomach, transverse colon, and greater omentum. The herniated viscera were reduced and primary diaphragmatic repair was performed. On postoperative day 1, a left pneumothorax causing respiratory distress was treated with anterior chest-tube drainage; the tube was removed on postoperative day 3. The patient improved and was discharged on postoperative day 8. Gastrothorax can closely mimic a traumatic pulmonary cavity. After blunt trauma, an unusual left thoracic air-fluid image should prompt systematic assessment of diaphragmatic continuity and the relationship of the lesion to the stomach before pleural intervention.