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Fig. 7B. —Type 4 paraesophageal hernia in 49-year-old woman. Axial CT images obtained with oral contrast material show entire stomach herniated intrathoracically (gastric fundus [F], body [B], antrum [A]). Esophagus is identified (arrows, A and B), and esophagogastric junction is seen (arrow, C). Duodenal bulb is also intrathoracic (asterisk, C). Lesser curvature is inferior to greater curvature and anterior to esophagus, and gastric fundus is located to left of and lateral to gastroesophageal junction. This indicates anterior mesenteroaxial rotation with resulting upside-down stomach. Additionally, there is herniation of transverse colon (arrowhead, C), indicating type 4 hernia.

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