Presentation
Retrosternal chest pain.
Patient Data
The gastroesophageal junction is displaced into the thorax, with an intercrural distance of 31mm. The gastric fundus and almost one-third of the stomach are contained within the hernia sac causing a posterior impression on the left atrium and superior left pulmonary vein, no compressive atelectatic lung changes, and no sign of aspiration. No abnormal rotation to suggest gastric volvulus. No obstruction or ischemia however focal circumferential gastric wall thickening was noted at the diaphragmatic impression at the hiatal neck.
Left adrenal gland: 5mm, well-defined lesion with an average density of <-5HU on a native study indicating a lipid-rich adenoma.
Bilateral peri-pelvic cysts effacing the pelvicalyceal system.
Case Discussion
Mixed (type III: combined sliding and rolling) hiatus hernia.
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