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Echocardiographic manifestation of hiatus hernia simulating a left atrial mass: case report.

Koskinas KC, Oikonomou K, Karapatsoudi E, Makridis P - Cardiovasc Ultrasound (2008)

Bottom Line: Despite the high prevalence of hiatus hernia, a relatively small number of echocardiographically manifested cases have been reported.An 82-year old woman presented with acute retrosternal pain indicative of cardiac etiology.Physical examination and biochemical tests, as well as 12-lead electrocardiogram, were normal.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cardiology Department, General Hospital of Edessa, 58200 Edessa, Greece. drkoskinas@yahoo.gr

ABSTRACT

Background: Despite the high prevalence of hiatus hernia, a relatively small number of echocardiographically manifested cases have been reported.

Case presentation: An 82-year old woman presented with acute retrosternal pain indicative of cardiac etiology. Physical examination and biochemical tests, as well as 12-lead electrocardiogram, were normal. A two-dimensional transthoracic echocardiogram was performed and revealed a structure that was considered to represent a left atrial mass. A subsequent computed tomography scan visualized a hiatus hernia in the posterior mediastinum, impinging on the posterior left atrial wall. The intrathoracic displacement of a large part of the stomach was further confirmed by an upper gastrointestinal barium examination.

Conclusion: Hiatus hernia can present as acute chest pain, while its echocardiographic manifestation may resemble a left atrial space-occupying structure. Physicians should be aware of the clinical and sonographic findings to facilitate the differential diagnosis from similarly presenting cardiac entities.

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Two dimensional transthoracic echocardiogram. A. Echocardiogram in parasternal long-axis shows an echolucent, apparent left atrial (LA) mass (arrowhead). B. M-mode scan through the ascending aorta and left atrium demonstrates the left atrial cavity significantly confined by the apparent mass (arrowhead).
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Figure 1: Two dimensional transthoracic echocardiogram. A. Echocardiogram in parasternal long-axis shows an echolucent, apparent left atrial (LA) mass (arrowhead). B. M-mode scan through the ascending aorta and left atrium demonstrates the left atrial cavity significantly confined by the apparent mass (arrowhead).

Mentions: A two-dimensional transthoracic echocardiogram, using all standard and modified apical and parasternal views, revealed an amorphous, echolucent mass with the appearance of a left atrial space-occupying lesion (Figure 1, see Additional file 1). Left ventricular contraction was normal and no pericardial effusion was present. The patient subsequently underwent a chest computed tomography (CT) scan; a large hiatus hernia was visualized in the posterior mediastinum (Figure 2). The intrathoracic migration of a large part of the stomach was confirmed by an upper gastrointestinal barium examination, which was performed after consulting a surgeon, to further assess the extent of the hernia and the potential need for surgical treatment (Figure 3).


Echocardiographic manifestation of hiatus hernia simulating a left atrial mass: case report.

Koskinas KC, Oikonomou K, Karapatsoudi E, Makridis P - Cardiovasc Ultrasound (2008)

Two dimensional transthoracic echocardiogram. A. Echocardiogram in parasternal long-axis shows an echolucent, apparent left atrial (LA) mass (arrowhead). B. M-mode scan through the ascending aorta and left atrium demonstrates the left atrial cavity significantly confined by the apparent mass (arrowhead).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2553061&req=5

Figure 1: Two dimensional transthoracic echocardiogram. A. Echocardiogram in parasternal long-axis shows an echolucent, apparent left atrial (LA) mass (arrowhead). B. M-mode scan through the ascending aorta and left atrium demonstrates the left atrial cavity significantly confined by the apparent mass (arrowhead).
Mentions: A two-dimensional transthoracic echocardiogram, using all standard and modified apical and parasternal views, revealed an amorphous, echolucent mass with the appearance of a left atrial space-occupying lesion (Figure 1, see Additional file 1). Left ventricular contraction was normal and no pericardial effusion was present. The patient subsequently underwent a chest computed tomography (CT) scan; a large hiatus hernia was visualized in the posterior mediastinum (Figure 2). The intrathoracic migration of a large part of the stomach was confirmed by an upper gastrointestinal barium examination, which was performed after consulting a surgeon, to further assess the extent of the hernia and the potential need for surgical treatment (Figure 3).

Bottom Line: Despite the high prevalence of hiatus hernia, a relatively small number of echocardiographically manifested cases have been reported.An 82-year old woman presented with acute retrosternal pain indicative of cardiac etiology.Physical examination and biochemical tests, as well as 12-lead electrocardiogram, were normal.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cardiology Department, General Hospital of Edessa, 58200 Edessa, Greece. drkoskinas@yahoo.gr

ABSTRACT

Background: Despite the high prevalence of hiatus hernia, a relatively small number of echocardiographically manifested cases have been reported.

Case presentation: An 82-year old woman presented with acute retrosternal pain indicative of cardiac etiology. Physical examination and biochemical tests, as well as 12-lead electrocardiogram, were normal. A two-dimensional transthoracic echocardiogram was performed and revealed a structure that was considered to represent a left atrial mass. A subsequent computed tomography scan visualized a hiatus hernia in the posterior mediastinum, impinging on the posterior left atrial wall. The intrathoracic displacement of a large part of the stomach was further confirmed by an upper gastrointestinal barium examination.

Conclusion: Hiatus hernia can present as acute chest pain, while its echocardiographic manifestation may resemble a left atrial space-occupying structure. Physicians should be aware of the clinical and sonographic findings to facilitate the differential diagnosis from similarly presenting cardiac entities.

Show MeSH
Related in: MedlinePlus