PMC9929136_01
Case 1: preoperative and postoperative x-ray findings and intraoperative conditions: (A) encapsulated gas accumulation with mediastinal displacement; (B) encapsulated gas accumulation still exists after re-placing the thoracic drainage tube; (C) after adjusting the thoracic drainage tube, the wrapped gas accumulation disappeared, but the left costophrenic angle was vague, indicating the presence of pleural effusion; (D) after the operation, the diaphragm recovered to normal position and the lung expanded well; (E) hemorrhagic effusion in the abdominal cavity, obvious gastric edema and expansion, and enlarged diaphragm incision; (F) repair iatrogenic gastric perforation.
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F1
The x-ray showed an air-fluid level, suggesting an encysted hydropneumothorax with a mediastinal shift and a diagnosis of tension gastrothorax (Figure 1A). However, the left costophrenic angle was unclear, indicating pleural effusion (Figure 1B,C). After enlarging the diaphragm incision, all organs were brought into the abdominal cavity; iatrogenic gastric perforation and diaphragmatic defects were repaired (Figure 1E,F). Postoperative x-ray was normal (Figure 1D).
PMC9929136_02
Case 2: preoperative CT, postoperative x-ray manifestations, and intraoperative conditions: (A) encapsulated gas accumulation with mediastinal displacement; (B) stomach and part of colon herniated into the thoracic cavity; (C) left lung was atelectasis and compressed to the upper of the stomach; (D) after the operation, the diaphragm recovered to normal position and the lung expanded well; (E) the hernia sac mouth is small, and the spleen and part of colon herniated into it; (F) the spleen had returned to the abdominal cavity and presented the hollow and herniated stomach in the thoracic cavity.
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F2
The diagnosis was tension gastrothorax (Figure 2A-C). All herniated organs were brought into the abdominal cavity, and the diaphragmatic defects were repaired (Figure 2E,F). The postoperative radiographs were normal (Figure 2D).
PMC9929136_03
Case 3: x-ray manifestations before and after operation: (A) encapsulated gas accumulation with mediastinal displacement; (B) the gastric tube is not bent, and its distal end is located in the stomach; (C) after adjusting the gastric tube for the complete decompression, there was no encapsulated gas accumulation with mediastinal displacement.
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F3
The x-ray showed an air-fluid level, suggesting an encysted hydropneumothorax with a mediastinal shift and a diagnosis of tension gastrothorax (Figure 3A). After injecting 20 ml of iohexol into the stomach tube, we immediately performed an x-ray and found that the stomach tube was not bent, and the distal end was located in the stomach (Figure 3B). The x-ray showed no encapsulated hydropneumothorax and a medial shift (Figure 3C).