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Large Hiatal Hernia with Floppy Fundus: Clinical and Radiographic Findings

¹ Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.
² Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —66-year-old woman with postprandial chest pain and epigastric pain. Upright steep left posterior oblique radiograph from double-contrast upper gastrointestinal examination shows large hiatal hernia. Gastric fundus (large black arrows) has flopped inferiorly beneath most superior portion of gas-filled gastric body (large white arrow). Pooling of barium in floppy fundus is evident, as is small amount of barium spilling into portion of stomach (small black arrows) that traverses diaphragm. Small white arrow denotes location of gastroesophageal junction above diaphragm.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —66-year-old woman with postprandial chest pain and epigastric pain. Supine steep left posterior oblique radiograph from same examination as A shows inferior location of floppy fundus (large black arrows) in relation to most superior portion of gastric body (small black arrow). Stomach (large white arrow) narrows where it traverses diaphragm. Small white arrow denotes location of gastroesophageal junction above diaphragm.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —66-year-old woman with postprandial chest pain and epigastric pain. Prone right anterior oblique radiograph later in same examination as A and B shows gastric fundus (black arrows) in expected location above intrathoracic portion of gastric body so that fundus is no longer flopped inferiorly. White arrow denotes location of gastroesophageal junction above diaphragm. Symptoms resolved after laparoscopic reduction of hernia.

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —61-year-old woman with nausea, regurgitation, postprandial epigastric pain, and early satiety. Upright steep right posterior oblique radiograph from double-contrast upper gastrointestinal examination shows retention of barium in floppy fundus (small arrows) with delayed emptying of hernia. Large arrow denotes narrowing of gastric body where it traverses diaphragm. Symptoms resolved after laparoscopic reduction of hernia.

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