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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).
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