Hiatus hernia

Case contributed by Mostafa El-Feky
Diagnosis almost certain


Dyspnea, productive cough, and GERD.

Patient Data

Age: 65 years
Gender: Female



Evidence of a large hiatal hernia with a hernial defect (widened esophageal hiatus) of about 5 cm, through which most of the stomach (fundus and body) is seen herniating into the chest cavity with displaced gastro-esophageal junction upwards, together with some herniating perigastric fat. This is associated with mild mediastinal shift to the right. No associated gastric volvulus noted.

Subsegmental compression/relaxation collapse and atelectatic bands of the left lower lung lobe.

Aberrant right subclavian artery, indenting the posterior oesophagal wall.

Gross cardiomegaly with dilated great vessels.

Case Discussion

A large hiatus hernia (sliding type), transmitting most of the stomach and upward displaced gastro-esophageal junction (type 3), sparing the antrum and pylorus. Hiatus hernia can progress to such size due to negative intrathoracic pressure. Assessment of the orientation of the herniated stomach is essential to rule out a possible associated gastric volvulus. This type of hernia is managed surgically.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.