Giant hiatal hernia
Symptoms of chronic oesophageal reflux.
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Large mediastinal lucency with layering fluid. Minimal to absent gastric air bubble.
Mildly elevated left hemidiaphragm with likely small left-sided pleural effusion.
With the large mediastinal lucency and minimal (or absent) gastric air bubble, a large paraoesophageal 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.