Large hiatus hernia

Case contributed by Dr James Sheldon

Presentation

Chest pain

Patient Data

Age: 87 years
Gender: Female
Modality: X-ray

Lucency in a retrocardiac location. This may represent a hiatus hernia.

Modality: CT

 

Large hiatus hernia containing the entire stomach (not distended and does not appear volved), body and tail of pancreas, large bowel (splenic flexure), omentum and vessels (including splenic artery and vein). Normal enhancement of the stomach wall.

Intrahepatic biliary dilatation. The CBD measures up to 13mm, which even in this age group and post-cholecystectomy is more prominent than expected. Dilated pancreatic duct within the pancreatic head (6mm). Air and fluid filled duodenal diverticulum.

Calcified liver granulomas. Subcentimetre hypodense right kidney lesions too small to definitively characterise on CT but likely cysts.

2.7cm x 2.2cm x 3.0cm left adnexal mass, possibly ovarian in origin although the left ovary is not identified.

Case Discussion

HH containing stomach may result in gastric volvulus, which in turn presents as intestinal obstruction and may result in ischaemia/infarction. 

The stomach does not appear volved on this study.

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Case Information

rID: 36920
Case created: 17th May 2015
Last edited: 3rd Dec 2015
Inclusion in quiz mode: Included

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