• Deepwant Singh, Pieter Mackeith, and Dipesh Pravin Gopal.
• West Suffolk Hospital, Suffolk, United Kingdom. Address: West Suffolk Hospital, Hardwick Lane, Bury Saint Edmunds, Suffolk IP33 2QZ, United Kingdom. Email: singhrheumatology@gmail.com.
• Medwave. 2016 Mar 23; 16 (2): e6409.

AbstractA previously well 71-year-old woman presented to the Emergency Department with acute-onset left-sided chest pain. She was haemodynamically stable with unremarkable systemic examination. Her electrocardiogram and troponin were within normal limits and her chest radiograph showed a raised left hemi-diaphragm. Two hours after admission, this woman became acutely breathless, and suffered a pulseless electrical activity cardiac arrest. After cardiopulmonary resuscitation, there was a return of spontaneous circulation and regained consciousness. A repeat clinical assessment revealed a new left-sided dullness to percussion with contralateral percussive resonance on respiratory examination. CXR revealed a left pan-hemi-thoracic opacity whilst better definition using CT-pulmonary angiography (CTPA) indicated an acute tension gastrothorax secondary to a large left-sided diaphragmatic hernia. Nasogastric (NG) tube insertion was used to decompress the stomach and the patient underwent uncomplicated emergency laparoscopic hernia reduction. She remained well at 1-year follow-up.

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