1/37. Right-sided hiatal hernia of the oesophagus.At chest radiography performed for recurrent pneumonia in a 3-month-old boy, an air-fluid level in the right cardiophrenic angle was found and initially perceived as a lung abscess. upper gastrointestinal tract radiographs, however, revealed a congenital diaphragmatic hernia, which was successfully repaired.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/37. Intrathoracic omental herniation through the esophageal hiatus: report of a case.We report herein an extremely rare case of intrathoracic omental herniation through the esophageal hiatus. In fact, according to our review of the literature, only eight other cases have been reported, most of which were misdiagnosed as mediastinal lipoma after being identified as an intrathoracic mass. We report herein the ninth case of intrathoracic omental herniation through the esophageal hiatus. A 54-year-old obese woman was admitted to our hospital for investigation of a chest roentgenographic abnormality. She was asymptomatic, and her physical examination and laboratory data were all within normal limits. Her chest X-ray demonstrated a large, sharply-defined mass, and a computed tomography scan of the thorax indicated a large mediastinal mass with fat density. A thoracotomy was performed under the diagnosis of a mediastinal lipoma which revealed an encapsulated fatty mass, 10x7.5x6 cm in size, that proved to be an omental herniation through the esophageal hiatus. There was no herniation of the stomach or intestines into the thorax. The esophageal hiatus was repaired after the omental mass and hernia sac had been resected. This case report serves to demonstrate that whenever a mass of fat density is recognized in the lower thorax, an omental herniation should be borne in mind as a possible differential diagnosis.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
3/37. Paraesophageal hernia in an elderly woman with vomiting.We describe the case of a 79-year-old woman who presented with resolved episodes of vomiting and was found to have a paraesophageal hernia. Her initial evaluation was unremarkable, and the diagnosis was established only by the use of screening chest radiography. Once the diagnosis was confirmed, the patient required urgent surgical repair. Paraesophageal hernia is a rare clinical entity with the potential for life-threatening complications, making the diagnosis itself an indication for surgery. This case illustrates the fact that significant pathology may be present with few, if any, physical findings in the elderly patient, and thorough evaluations are required for the diagnosis of such occult pathology.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/37. Giant gastrointestinal stromal tumor, associated with esophageal hiatus hernia.An 85-year-old woman was admitted to our hospital because of vomiting. An upper gastrointestinal series what showed a large esophageal hiatus hernia, suggesting an association with extrinsic pressure in the middle portion of the stomach. An upper gastrointestinal endoscopic examination showed severe esophagitis and a prominent narrowing in the middle portion of the stomach, however, it showed normal gastric mucosa findings. CT and MRI revealed a large tumor extending from the region of the lower chest to the upper abdomen. From these findings, the tumor was diagnosed as gastrointestinal stromal tumor (GIST), which arose from the gastric wall and complicated with an esophageal hiatus hernia. We performed a laparotomy, however, the tumor showed severe invasion to the circumferential organs. Therefore, we abandoned the excision of the tumor. Histologically, the tumor was composed of spindle shaped cells with marked nuclear atypia and prominent mitosis. The tumor cells were strongly positive for CD34 and c-kit by immunohistochemical examination. From these findings, the tumor was definitely diagnosed as a malignant GIST. As palliative treatment, we implanted a self-expandable metallic stent in the narrow segment of the stomach. The patient could eat solid food and was discharged. In the treatment of esophageal hiatus hernia, the rare association of GIST should be considered.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/37. A massive hiatal hernia that mimics a congenital diaphragmatic hernia. An unusual presentation of hiatal hernia in childhood: report of a case.A massive hiatal hernia containing the colon, intestine, and stomach with organoaxial volvulus is an uncommon entity in childhood. This clinical form of a hiatal hernia may mimic congenital diaphragmatic hernia and chest pathologies. In this paper, we describe a patient who presented with a massive hiatal hernia that mimicked a congenital diaphragmatic hernia, and discuss the pitfalls in diagnosing this clinical entity.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
6/37. Isolated trans-hiatal colonic herniation.Isolated herniation of the colon through congenital or traumatic diaphragmatic defects are well documented. However, trans-hiatal herniation of the colon in the absence of an intrathoracic stomach has been reported only once. A 67-year-old man presented with intragastric abdominal pain and a chest x-ray film documenting a posterior mediastinal air-fluid level. Computed tomography showed gastrointestinal contents within the thorax. The findings on an upper gastrointestinal film with small bowel follow-through were normal. Finally, a barium enema identified transverse colon within the thoracic cavity. At laparoscopy, the entire transverse colon was reduced with the hernia sac. The crural defect was repaired, and a Toupet fundoplication was performed. A gastropexy was also added. The patient was discharged on postoperative day 2 able to tolerate a regular diet, and he has been asymptomatic for 5 months. This defect most likely represents a congenital deformity of the diaphragm with intact posterior gastric attachments, including the posterior phrenoesophageal ligament. An intact gastric mesentery enabled isolated colonic herniation with retention of the stomach its normal anatomic position. An antireflux procedure was performed in addition to the crural repair because of the circumferential dissection of the esophagus. This article is the second report of an isolated trans-hiatal herniation of the colon and the first report of laparoscopic repair of this entity.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
7/37. Combination of paraesophageal hernia and Morgagni hernia in an old patient.Paraesophageal hiatal hernia is an uncommon condition that requires urgent correction to prevent life-threatening complications. It is present in 14% of all hiatal hernias. The incidence of Morgagni hernia among all diaphragmatic defects is 3-4% and about 90% of the hernias occur on the right, 8% are bilateral and 2% are on the left. The combination of a Morgagni hernia and paraesophageal hernia is very rare and only four cases have been reported in the literature. All of them occurred in the right. This report describes an old case admitted to our clinic with dyspnea, chest pain and chronic gastrointestinal symptoms, found to have combined left Morgagni and paraesophageal hernia. Surgical repair was performed via transabdominal approach. This unusual case and surgical approaches are discussed in light of the data presented in the literature.- - - - - - - - - - ranking = 4.1138314366457keywords = chest pain, chest (Clic here for more details about this article) |
8/37. Parahiatal hernia with gastric obstruction in a child.Parahiatal hernia refers to herniation of abdominal viscera into the chest adjacent to an intact hiatus. Spontaneously occurring parahiatal herniae are extremely rare. We report a 4-year-old boy who presented with intermittent vomiting and had such a hernia, where the herniated stomach had undergone partial volvulus. He was symptom-free after surgical repair.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
9/37. Laparoscopic approach for early gastric cancer within a paraesophageal hiatal hernia.We present a case of early gastric cancer located in gastric volvulus associated with paraesophageal hiatal hernia. Two lesions of EGC were diagnosed in the distal third of the stomach, most of which had herniated into the left chest through a large hiatal defect in an organoaxial fashion. Routinely, laparoscopic-assisted distal gastrectomy (LADG) is our preferred approach for EGC, and the presence of hiatal hernia in this case did not alter our approach. Laparoscopic repair of hiatal hernia was performed successfully followed by LADG. A review of the literature supports a minimally invasive approach for both procedures and shows it to be safe, effective, and technically feasible. Further, LADG is shown to be oncologically adequate in terms of tumor margins and lymph node dissection, but its relevance to long-term disease-free survival still needs to be studied in well-designed prospective trials.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
10/37. Paraesophageal hernia in the neonatal period: suspicion on chest X-ray.The paraesophageal hernia is rarely seen in the neonatal period. Presentation in neonatal period can be confused with the possibility of esophageal atresia or esophageal web. The upper gastrointestinal tract contrast study is diagnostic in this disease, but careful viewing of the plain X-ray of the chest can also lead to suspicion of the diagnosis. Two neonates with para-esophageal hernia are reported, one with the mesenterico-axial volvulus and the second neonate without volvulus.- - - - - - - - - - ranking = 5keywords = chest (Clic here for more details about this article) |
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