Diagnosis of hiatus hernia by computed tomography

Abstract

Hiatus hernia and phrenic ampulla are serendipitous CT findings. They may be seen with or without oral contrast and should not be mistaken for abnormal masses in the oncologic patient. When oral contrast is used, esophageal reflux may be demonstrated and may be the cause of epigastric or substernal pain. Knowledge of the esophagogastric anatomy is essential in making the proper diagnosis. 13-mm collimator. Scans were obtained at 2 cm or less through the lower chest and abdomen following ingestion of 300 ml of a 5% Gastrografin (E. R. Squibb & Sons, Inc.) solution 30 min prior to the study and another 200 ml 5 min before scanning. This solution was given to the patient in the upright position and all scanning was performed with the patient supine. Thus, the recently ingested contrast gravitated to the dependent gastric fundus. Hiatus hernia alone was present in 6 patients, associated reflux was noted in 4, phrenic ampulla was demonstrated in 1, reflux alone was evident in 1, and one elderly patient exhibited a hiatus hernia with associated esophageal tertiary contractions and presbyesophagus. In the evaluation of patients with intra-abdominal disease, the demonstration of hiatus hernia is usually a serendipitous finding. Recognition of this entity is important, especially in oncologic practice, for it must not be mistaken for a soft-tissue tumor or adenopathy. Furthermore, awareness of the presence of a hiatus hernia would be important should the patient have or later develop epigastric symptoms, or those of esophageal reflux. This communication describes the anatomy at the distal esophageal level; the CT appearance of hiatus hernia, phrenic ampulla, and esophageal reflux; and confirmation of the CT findings by barium swallow. CT FINDINGS