PMC7750025_01
Chest radiograph showing (A) excessive gastrointestinal gas in the mediastinum or the left side of the chest cavity. A marked right-sided displacement of the mediastinal shadow is observed. In addition, a marked right-sided displacement of the trachea can be seen. (B) The expanded stomach was decompressed by the insertion of a nasogastric (NG) tube, which led to the reversal of the mediastinal displacement.
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Coma Scale score of 12 (E4V3M5), blood pressure of 98/71 mmHg, pulse of 119/min, temperature of 36.5 C, tachypnea (>=30 times/min), and 85% oxygen saturation (on room air), with diminished breath sounds on the left side. Chest X-ray revealed a large gastric bubble in the left chest cavity, with the mediastinum strongly displaced to the right side (Fig. 1A). Chest X-ray performed after the gastric tube insertion revealed normal mediastinal structures and the absence of the previously present giant gastric bubble in the mediastinum (Fig. 1B).
Chest and abdominal computed tomography scans (plain films) showing a significantly dilated stomach incarcerated within the mediastinum. A marked displacement of the heart and the left lung can be observed. Craniocaudal inversion of the incarcerated stomach, leading to an "upside-down stomach," can also be visualized. IVC, inferior vena cava.
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There was no evidence of pneumonia (Fig. 2).
Chest radiograph on the second day of hospitalization reveals no stomach dilation within the mediastinum or mediastinal displacement; however, extensive infiltrative shadows are seen in both lung fields, suggesting severe pneumonia.
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Subsequently, the correction of dehydration by infusion stabilized both the blood pressure and tachycardia; however, because she developed aspiration pneumonia, her respiratory status did not improve and she died on the fourth hospital day (Fig. 3).