CT
Axial C+ portal venous phase
In this patient with a para-esophageal hernia, the esophago-gastric junction is located inferiorly to the gastric antrum, and there is moderate gastric distension. A little quantity of free fluid is seen near the gastric fundus and surrounding the intra-thoracic stomach. The findings are highly suggestive of mesentero-axial gastric volvulus. Surgical consultation is recommended.