What is the differential diagnosis of this CXR appearance?
The film was initially reported as a significantly raised left hemidiaphragm with distended gastric bubble raising the possibility of gastric volvulus. The differential diagnosis also includes a hiatus hernia, an intrapulmonary cavitating lesion, or a pleural collection such as a hydro- or pyopneumothorax. A CT scan was subsequently performed.
Large gas-containing collection in the left hemithorax with air-fluid level. There is loss of the left heart and left hemidiaphragm silhouette and slight mediastinal shift to the right. Overlying atelectasis in the left midzone. Gas within the stomach or colon is noted in the left upper quadrant.