Presentation
Dyspnea, productive cough, and GERD.
Patient Data
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.
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