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Fig. 9B. —Type 4 paraesophageal hernia in 71-year-old woman. Radiographs from barium upper gastrointestinal series show barium-filled stomach is displaced in its entirety into right chest (B). Fundus is located to right and posterior to esophagogastric junction. Esophagogastric junction is displaced anteriorly, and stomach projects posteriorly to esophagogastric junction. These findings indicate posterior organoaxial rotation. Mesenteroaxial component is also present because antrum is located cephalad to gastric corpus. Differential barium level (arrows, B) shows typical mechanism of double fluid level sign, as occasionally seen on chest radiography (not shown). Additional air-containing viscera are seen in chest (arrows, C).