A Stomach Through the Eyes of EBUS Bronchoscopy

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Introduction: Hiatal hernias are frequently an incidental finding on an upper endoscopy, barium swallow, manometry study or abdominal/chest imaging. We present the first reported case of a sliding hiatal hernia as an incidental finding on EBUS bronchoscopy. Case Report: A 72-year-old man with a history of a pituitary macroadenoma was transferred to the medical ICU with altered mental status, hypotension and worsening of non-productive cough. Upon further workup, a computed tomography of the chest demonstrated mediastinal adenopathy in addition to migration of subdiaphragmatic stomach into the chest cavity (Figure 1). While navigating the airway with EBUS bronchoscopy, stomach tissue was identified at the medial wall of the left main bronchus consistent with a hiatal hernia (Figure 2).Figure 1: CT scan demonstrating hiatal hernia.Figure 2: Endobronchial ultrasound (EBUS) bronchoscopy revealing contour of a stomach at the medial wall of the left main bronchus.Discussion: A hiatal hernia is described by the protrusion of the gastroesophageal junction into the chest cavity. It can be seen in up to 80% of the general population. It is usually suspected in patient with gastroesophageal reflux disease and has been associated with Barrett’s esophagus. It is frequently an incidental finding on an upper endoscopy, barium swallow, manometry study or abdominal/chest imaging. Hiatal hernia has been recently reported as an extra-cardiac finding on echocardiographic exams. To the best of our knowledge this is the first reports of a sliding hiatal hernia as an incidental finding on EBUS bronchoscopy.