Gastric emphysema is a relatively rare finding and could represent potentially serious pathology. 

Differentials include:

• raised intragastric pressure (eg. gastric outlet obstruction)
• post-gastroscopy (from air insufflation from instrumentation)
• severe mucosal injury (eg. from violent vomiting)
• dissection of air from the mediastinum (eg. pneumothorax)

Emphysematous gastritis is the other cause of this radiographic appearance and represents proliferation of gas-forming microorganisms in the gastric wall. This condition has a poor prognosis and primary treatment is with broad-spectrum intravenous antibiotics, intravenous fluids and nutritional support.