Transesophageal Two-Dimensional Echocardiographic Identification of Hiatal Hernia

Echocardiographic Features of Postesophagogastrectomy Intrathoracic Stomach Mimicking Intracardiac Mass

Under certain abnormal conditions, part or all of the stomach can migrate through the diaphragm into the thorax. These conditions include congenital defects in the diaphragm and traumatic rupture of the diaphragm (commonly resulting from automobile accidents). A more common cause of partial translocation of the stomach into the chest is a sliding hernia through the esophageal hiatus itself. Intrathoracic stomach can also be iatrogenic; in this article, the authors describe the echocardiographic findings of a patient in whom carcinoma of the esophageal-gastric junction was resected and the cut ends of the esophagus and stomach anastomosed by bringing the stomach up into the thorax.

Echocardiographic manifestation of hiatus hernia simulating a left atrial mass: case report

BACKGROUND

Despite the high prevalence of hiatus hernia, a relatively small number of echocardiographically manifested cases have been reported.

CASE PRESENTATION

An 82-year old woman presented with acute retrosternal pain indicative of cardiac etiology. Physical examination and biochemical tests, as well as 12-lead electrocardiogram, were normal. A two-dimensional transthoracic echocardiogram was performed and revealed a structure that was considered to represent a left atrial mass. A subsequent computed tomography scan visualized a hiatus hernia in the posterior mediastinum, impinging on the posterior left atrial wall. The intrathoracic displacement of a large part of the stomach was further confirmed by an upper gastrointestinal barium examination.

CONCLUSION

Hiatus hernia can present as acute chest pain, while its echocardiographic manifestation may resemble a left atrial space-occupying structure. Physicians should be aware of the clinical and sonographic findings to facilitate the differential diagnosis from similarly presenting cardiac entities.

Large mass impinging on the left atrium: diagnostic value of a new cocktail

The differential for a large mass impinging on the left atrium should include a hiatal hernia. When a hiatal hernia is suspected, the patient can be asked to ingest a carbonated beverage. Oftentimes, the beverage and bubbles can help delineate the herniation on echocardiography. This technique can make the diagnosis, but it is not always successful. WE report a case of a patient with a large hiatal hernia which was clearly demonstrated by having the patient swallow a carbonated beverage mixed with 1.5 ml of activated Definity contrast media. This novel cocktail has not been described in the literature to date.

Echocardiographic aspects of hiatal hernia: A review

It was realized 20 years ago that the sonographic appearance of a diaphragmatic hernia could simulate a left atrial mass. Many papers have appeared on this topic since then, but they mainly consist of single case reports. Clinical symptoms due to cardiac compression by the hernia are uncommon but may occur if the hernia is very large; such patients have presented with episodes of syncope or dyspnea, typically after a large meal. Sonographers, cardiologists, gastroenterologists, and internists are generally not yet aware that sonographic presentations can be varied and are often perplexing. These include the combination of hiatal hernia with gastroesophageal reflux demonstrable in the subcostal view, and hiatal hernia in patients with ascites.