Stomach in Chest and Chest in Stomach

A 76-year-old woman presented with hypotension noted to be atrial fibrillation. Her medical history was significant for diabetes mellitus, hypertension, morbid obesity, end-stage renal disease, and gastroesophageal reflux disease with known large hiatal hernia. After presentation, she developed nausea, vomiting, and vague epigastric pain. Chest computed tomography (CT) demonstrated an intrathoracic stomach with superior displacement of the greater curvature, suggesting volvulus (Figure 1). Upper gastrointestinal series demonstrated an organoaxial volvulus (Figure 2). Esophagogastroduodenoscopy (EGD) to rule out ischemia revealed a largely intrathoracic stomach with suggestion of a twist, and a friable, erythematous raised lesion was noted in the fundus (Figure 3). Pathology of the lesion revealed a metastatic carcinoma, consistent with primary breast cancer (Figure 4). Immunohistochemical staining revealed that the tumor cells were estrogen-receptor positive, focally progesterone-receptor positive, and negative for HER2 protien (Figure 4). Unfortunately, the patient soon developed sepsis and died before repeat EGD could be performed for detorsion and gastropexy.