Intrathoracic stomach

Case contributed by Dr Mostafa Mahmoud El Feky

Diagnosis certain

Presentation

Follow up after left breast lumpectomy

Patient Data

Age: 55

Gender: Female

From the case: Intrathoracic stomach

CT Chest with contrast

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Coronal C+ arterial phase

The stomach is herniated at the lower mediastinum with preserved gastroduodenal junction in place. It showed diffuse wall thickening (endoscopy not available). It displaces the descending thoracic aorta to the left side and compresses the surrounding lung parenchyma.

Other findings:

right sided aortic arch with aberrant left subclavian artery
cardiac enlargement
nodular goiter
fluid collection at the surgical bed of left lumpectomy
scoliosis of the lumbar spine with convexity to the right
right renal upper pole cyst

Case Discussion

Intrathoracic stomachs are rare and considered the end stage of a hiatus hernia. Type IV hiatus hernias are the total herniation of the stomach. Other organs can also be herniated into the chest such as the colon, omentum, small bowel, and liver.

In addition, there is a right-sided aortic arch with aberrant left subclavian artery (type II), which is displaced to the left side by the herniated stomach.