Gastric intramural air is a rare entity. It should be considered in the presence of an unusual gas pattern in the left upper quadrant on an abdominal radiograph. In many cases, the stomach circumference is outlined with linear lucencies. In others, such as our case, the intramural air is more localized and a mottled gas pattern is seen in the left upper quadrant. A CT scan will confirm the presence of air in the stomach wall, demonstrate the extent, show portal venous air if present and may also give valuable information regarding the underlying cause.

Gastric emphysema has many etiologies which can be broadly divided into gastric and extragastric causes. Emphysematous gastritis is clinically distinct from the other causes as the patient is seriously ill and has a poor prognosis. On the contrary, other causes of gastric emphysema usually respond well to conservative management and the condition tends to resolve spontaneously, as was the case with our patient. Zenooz et al¹ report a case of gastric emphysema secondary to intramural nasogasrtic tube placement.

I wish to acknowledge the contribution of Dr Suzanne Shine, Consultant Radiologist, and Dr Jan Gerstenmaier, Radiology Registrar, St. Vincent's University Hospital, Dublin, Ireland.