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Hiatal Hernia

Hiatal Hernia. Radiology case presentation 8/17/07. Patient background. 63 year old female HPI: Recent months complaining of symptoms of dysphagia especially solids(bread). Pain in the epigastric region in supine and aggravated with the valsalva. PMH. Hiatal hernia Type III

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Hiatal Hernia

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  1. Hiatal Hernia Radiology case presentation 8/17/07

  2. Patient background • 63 year old female • HPI: Recent months complaining of symptoms of dysphagia especially solids(bread). Pain in the epigastric region in supine and aggravated with the valsalva.

  3. PMH • Hiatal hernia Type III • Abnormal esophageal Motility and LES mamometry. • Recurrent Pneumonia and SOB • Collis Nissen repair in 2004.

  4. Differential diagnosis • Achalasia • Chaga’s dz: Trypanosomiasis • Scleroderma: fribrotissue replacement of muscle • Phrenic ampulla ( corresponds to the location of LES • Epiphrenic diverticulum • Post surgical change

  5. Comorbid conditions • Diverticulum (25%) • Esophageal dysmotility

  6. Diverticulum

  7. Peristalsis • Teritary contractions present. • ? Nissen or at least should make the nissen less tight to avoid dyphagia.

  8. Characteristics of hernia • B ring • wrap “above” the diaphragm • Railroad track: Magenstrassa • Plan film: can demonstrate air fluid level in area of heart.

  9. Note the cystic structure (ant. Herniation)

  10. B ring (z line) squamocolumnar conjunction (green arrow) • Anatomic: at ridge of gastroesophogeal junction (Crus)

  11. Hernia from different angle Hernia Diaphragm

  12. Ba pill versus solution - picture demonstrates solid dysphagia Wrap Ba pill

  13. Patient’s hospital course • Patient seen as outpatient and to be evaluated with EDG before final decision to be made.

  14. Reference • Mettler, F. (2005). Essentials of Radiology 2nd ed. USA: Saunders. Retrieved July 31 2007 from Mdconsult online electronic medical library: http://www.mdconsult.com

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