Acute gastric volvulus presenting as pseudo cardiac tamponad
The present case has been reported in BMJ. Gastric volvulus is defined as rotation of the stomach or part of the stomach by more than 180°, creating a closed loop obstruction. Typically, its clinical presentation includes abdominal pain, distension, nausea and vomiting.

Diagnosis requires a high suspicion index as it can be easily misdiagnosed with other abdominal problems such as stomach distension or subocclusive syndrome. CT scan has proven to be both highly sensitive and specific when differentiating these processes.

A woman in their early 80s with no relevant medical background presented at out hospital with nausea and progressive dyspnoea for 3 days. She did not mention chest pain, cough, fever or other symptoms. Physical examination revealed tachycardia (122 bpm), tachypnoea (35 bpm), low arterial pressure (90/67 mm Hg), diminished heart sounds, jugular ingurgitation and basal left hypophonesis.

Chest radiography revealed massive hiatal hernia and urgent tomography confirmed hiatal hernia and an intrathoracic gastric volvulus, which partially compressed the heart.

Learning points
• Acute gastric volvulus requires an emergent surgical approach in order to avoid ischaemia, perforation or death.

• Intrathoracic masses that compress the heart can mimic classical cardiac tamponade in the absence of pericardial effusion.

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