García-Regalado Juan F, Navarro-Rojas Mariana M
Rev Chil Pediatr. 2014 Jul;85(4):476-80. doi: 10.4067/S0370-41062014000400011.
Tension gastrothorax is caused by the herniation of the stomach into the thorax due to a congenital defect of the diaphragm; the Bochdaleck diaphragmatic hernia (HDB) is the most frequent type.
Tension gastrothorax should be considered as a differential diagnosis in patients with obstructive shock and tension pneumothorax.
A previously healthy 10 month-old male infant, who presented increased respiratory distress, increased volume of the left hemithorax, absence of breath sounds, ipsilateral hyper-resonance, 76% saturation, cold skin and capillary filling > 5 seconds, followed by a cardio-respiratory arrest. Due to clinical suspicion of pneumothorax, needle decompression was performed reversing cardiac arrest, but with persistent hemodynamic and respiratory instability; chest radiograph suggested diaphragmatic hernia. He underwent surgery confirming the presence of a diaphragmatic hernia of 5 cm.
The evolution of this case shows the difficulty differentiating a tension gastrothorax from tension pneumothorax in patients admitted to the emergency room who are in serious condition; therefore, a high index of suspicion is needed for its identification.
张力性胃胸腔是由于膈肌先天性缺陷导致胃疝入胸腔所致；博赫代克膈疝（HDB）是最常见的类型。
在患有梗阻性休克和气胸的患者中，应将张力性胃胸腔视为鉴别诊断。
一名先前健康的10个月大男婴，出现呼吸窘迫加重、左半胸容积增大、呼吸音消失、同侧过清音、饱和度76%、皮肤冰冷且毛细血管充盈时间>5秒，随后发生心肺骤停。由于临床怀疑气胸，进行了针吸减压，逆转了心脏骤停，但仍存在持续的血流动力学和呼吸不稳定；胸部X线片提示膈疝。他接受了手术，证实存在一个5厘米的膈疝。
该病例的病程表明，在病情严重的急诊患者中，区分张力性胃胸腔和气胸存在困难；因此，需要高度怀疑才能识别它。
