This is an advanced stage of hiatal hernia, in which the stomach is entirely located in the thoracic cavity. This may predispose to gastric volvulus which fortunately is not present in this case.

The patient presented again after 6 months to the cardiologist with exertional dyspnea. Echocardiography (not available) revealed compression upon the left atrium by the compression effect of the stomach and normal right atrium size. This is contrary to pericardial effusion pressure effect, at which the right atrium collapses first.