Paraesophageal hernia is the second most type of hiatal hernias. It is a known predisposing factor for gastric volvulus. When acute gastric volvulus occurs, early diagnosis before strangulation and incarceration will be life-saving. We are presenting a case with paraesophageal hernia and gastric volvulus with unusual radiologic findings. The patient came to emergency room with acute symptoms. The diagnosis was made with multidetector computed tomography (MDCT). Three spherical gas bubbles were seen in the chest X-ray. Two of them were intrathoracic and the third one was intraabdominal. MDCT showed that most of the stomach was in the chest alongside the esophagus. Gas in the portal veins and gastric wall was also seen. The patient was treated with surgery. © 2009 Elsevier Ireland Ltd. All rights reserved.