Computed tomographic evaluation of paraesophageal hernia

Abstract

Paraesophageal hernias are relatively rare compared to the more commonly diagnosed sliding hiatus hernia. They tend to be asymptomatic initially, but may gradually enlarge and present with life-threatening complications. The treatment is surgical reduction, preferably as an elective procedure. Computed tomography (CT) clearly demonstrates a paraesophageal hernia through a widened esophageal hiatus, often as an incidental finding, and accurately documents the size, contents, and orientation of the herniated stomach within the lower thoracic cavity. In this report, the CT appearance of 4 patients with paraesophageal hernias is described along with a discussion of this uncommon but important surgical condition.

Primary paraesophageal hernia in children

“…Computed tomography is reported to be helpful in that it documents the widened esophageal hiatus; hiatal size and content; the orientation of the stomach; and the hernia's position, to the right, straddling, or more to the left of the midline [13]. We found no use for this as a diagnostic method, and computed tomography was only performed in one patient before referral to our service.…”

Clinical implication of hiatal hernia in patients with right isomerism

“…The hiatus of the oesophagus could clearly be discerned on the CT films [12][13][14]. The increased distance between the crura of the diaphragm and even an additional soft mass density noted in the oesophageal hiatus indicated the presence of hernia of the stomach protruding into the hiatus [12][13][14]. The CT films of the study patients were carefully reviewed retrospectively for the presence of hiatal hernia by one of the authors, a radiologist specialized in paediatric cardiology, who was blind to the clinical symptoms.…”

“…The ultrafast CT, which provided distinct images of the cardiac structure in the avoidance of heart beat interference, also provided insight into the structures of the thoracic and upper abdominal cavities, including the airway, diaphragm, oesophagus, hiatus, proximal stomach and spleen. The hiatus of the oesophagus could clearly be discerned on the CT films [12][13][14]. The increased distance between the crura of the diaphragm and even an additional soft mass density noted in the oesophageal hiatus indicated the presence of hernia of the stomach protruding into the hiatus [12][13][14].…”

Hiatal hernias

“…3a, b) is reported to be helpful by demonstrating the widened esophageal hiatus, hiatal size and content, the orientation of the stomach, and the hernia's position (Fig. 4) [66].…”