Tension gastrothorax in late diagnosis of congenital diaphragmatic hernia

Tension gastrothorax is a rare but potentially fatal complication of congenital diaphragmatic hernia, frequently mistaken for tension pneumothorax. Early recognition is essential to avoid delays in definitive management. We describe the case of a 14-month-old boy who presented with sudden respiratory distress and non-productive vomiting. Imaging revealed a tension gastrothorax caused by herniation of the stomach, spleen, and colon through a diaphragmatic defect. The patient underwent emergency surgery with successful reduction of the herniated organs and repair of the defect. This case highlights the importance of considering tension gastrothorax in the differential diagnosis of acute pediatric respiratory distress with mediastinal shift. CT imaging plays a crucial role in accurate diagnosis, and timely surgical intervention is lifesaving.