Ongoing chest and epigastric pain. Background history of reflux.
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Normal cardiomediastinal outline.
No evidence of active cardiopulmonary process.
Air and fluid filled structure behind the heart most likely representing a large hiatus hernia.
No subdiaphragmatic free air.
1 case question available
There are multiple causes for chest pain, most commonly cardiac and pulmonary related pathologies.
It is important however to remember that the digestive system, especially abnormalities of the oesophagus and stomach, may be the cause of central chest pain.
This case also emphasises the importance of looking carefully at review areas on chest x-rays.