Presentation
Epigastric pain and vomiting.
Patient Data
Esophagogastric junction is located in normal sub diaphragmatic location but large portion of proximal of stomach is herniated into thorax.
Esophagogastric junction is located in normal sub diaphragmatic location but large portion of proximal of stomach along with proximal of duodenum are herniated into thorax through dilated diaphragmatic hiatus. No gastric wall ischemic changes in current study.
Mild subsegmental collapse is present at left lower and lingular lobes.
Several small calcified foci are seen at right liver lobe, less than 7 mm in diameter.
Several parapelvic cysts are seen at left kidney less than 25 mm in diameter.
Case Discussion
Features are compatible with large para-esophageal hiatal hernia (type IV), also known as rolling hernia, which is an uncommon type of hiatal hernia representing ~10% of all hiatal hernias. The majority of hiatal hernias are the "sliding" type (type I).
At first, this looks like a type II ("para-esophageal") hernia, but on further examination the majority of the stomach is above the diaphragm with duodenum appearing to be partly in the hernia. Type IV seems to fit this hernia better, but it seems to have features of both categories.