Giant hiatal hernia

Presentation

Symptoms of chronic esophageal reflux.

Patient Data

Age: 48
Gender: Male
X-ray

Large mediastinal lucency with layering fluid. Minimal to absent gastric air bubble.

Mildly elevated left hemidiaphragm with likely small left-sided pleural effusion.

Case Discussion

With the large mediastinal lucency and minimal (or absent) gastric air bubble, a large paraesophageal hernia or a total intrathoracic stomach should be considered. A CT of the chest and abdomen or an upper GI fluoroscopic study would be useful for further evaluation.

Endoscopic examination was compatible with the radiographic findings.

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