This patient with a long psychiatric history was found to be eating a lot of hair and eventually starting vomiting.
CT shows a large mass completely distending the stomach consistent with a giant hairball based on the given history.
CT in the lung/air window shows a few tiny foci of air outside of the stomach (arrows), not where there should be any air at all. This is consistent with a small perforation of the stomach.
See here for another case of bezoar causing stomach obstruction.
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Dang, I’d never considered this aspect of hair and bowel obstructions before.
You learn how all kinds of things, from the relatively mundane + bad luck to the weird and wacky, can cause serious health issues in radiology.