Hiatal Hernia

1
Hiatal Hernia

• Radiology case presentation
• 8/17/07

2
Patient background

• 63 year old female
• HPI Recent months complaining of symptoms of
  dysphagia especially solids(bread). Pain in the
  epigastric region in supine and aggravated with
  the valsalva.

3
PMH

• Hiatal hernia Type III
• Abnormal esophageal Motility and LES mamometry.
• Recurrent Pneumonia and SOB
• Collis Nissen repair in 2004.

4
Differential diagnosis

• Achalasia
• Chagas dz Trypanosomiasis
• Scleroderma fribrotissue replacement of muscle
• Phrenic ampulla ( corresponds to the location of
  LES
• Epiphrenic diverticulum
• Post surgical change

5
Comorbid conditions

• Diverticulum (25)
• Esophageal dysmotility

6
Diverticulum
7
Peristalsis

• Teritary contractions present.
• ? Nissen or at least should make the nissen less
  tight to avoid dyphagia.

8
Characteristics of hernia

• B ring
• wrap above the diaphragm
• Railroad track Magenstrassa
• Plan film can demonstrate air fluid level in
  area of heart.

9
Note the cystic structure (ant. Herniation)
10

• B ring (z line) squamocolumnar conjunction (green
  arrow)
• Anatomic at ridge of gastroesophogeal junction
  (Crus)

11
Hernia from different angle
Hernia
Diaphragm
12
Ba pill versus solution - picture
demonstrates solid dysphagia
Wrap
Ba pill
13
Patients hospital course

• Patient seen as outpatient and to be evaluated
  with EDG before final decision to be made.

14
Reference

• Mettler, F. (2005). Essentials of Radiology 2nd
  ed. USA Saunders. Retrieved July 31 2007 from
  Mdconsult online electronic medical library
  http//www.mdconsult.com