Two‐ and Three‐Dimensional Transthoracic Echocardiographic Assessment of Hiatal Hernia

Abstract

Using two- (2DTTE) and three-dimensional transthoracic echocardiography (3DTTE) and an oral contrast agent (a carbonated beverage), a mass-like lesion behind the left ventricular posterior wall in an elderly female was definitively diagnosed as a hiatal hernia. A 3DTTE provided a more comprehensive evaluation of the hiatal hernia as compared to the 2DTTE in terms of its size and extent and thickness of the wall. The size of the hernia was underestimated by 2DTTE (3.3 x 3.2 cm) as compared to 3DTTE (at least 7 x 4.8 cm). The maximum thickness of the gastric wall was also found to be larger by 3DTTE (11 mm) as compared to 2DTTE (5 mm). Both the size of the hernia and thickness of the wall have important clinical implications. The size has been reported to be the strongest predictor of severity of esophagitis and gastric wall thickness of 10 mm or more has been associated with malignant or potentially malignant gastric lesions.

An Unusual Presentation of Diaphragmatic Hernia

“…However, diaphragmatic hernias are caused by congenital or traumatic defects in the diaphragm. In the literature, cases of hiatal hernia have more frequently been reported to simulate a mass adjacent to the left atrium due to its posterior location and may cause postprandial syncope, dyspnea, and arrhythmias if cardiac compression occurs 1,2 . However, only some congenital or traumatic diaphragmatic hernia localizes anteriorly and as in our case, may mimic a mass adjacent to the right atrium.…”

Left atrial compression and right ventricular outflow tract diameter on echocardiography are independently associated with exercise capacity in patients with large hiatal hernia

“…In the present study, LA compression correlated with baseline exercise capacity independent of cardiorespiratory comorbidities, suggesting a possible causal relationship between HH‐related compression and dyspnea. LA compression has been associated with cardiac symptoms in prior reports due to compression by HH as well as other posterior mediastinal masses . Potential mechanisms of exercise impairment secondary to LA compression include an inability of the LA to reach its maximal size, particularly during exercise when LA size increases to accommodate a larger reservoir volume .…”

Intrinsic and Extrinsic Cardiac Pseudotumors: Echocardiographic Evaluation and Review of the Literature

“…In the majority of cases, a hiatus hernia appears as a left atrial pseudotumor. 16,17 Hiatus hernia may present with typical gastroesophageal reflux symptoms or may cause cardiovascular signs and symptoms mimicking acute cardiovascular events, such as ischemic ECG changes, postprandial syncope, and angina-like chest pain. Direct compression of the heart can cause dyspnea leading to acute respiratory failure, pericardial effusion, arrhythmias, recurrent heart failure, and fistulas.…”