Imaging

Hiatal Hernia

Preliminary Diagnosis: Hiatal Hernia

I. What imaging technique is first-line for this diagnosis

  • Fluoroscopic guided barium study (esophagram or upper GI)

II. Describe the advantages and disadvantages of this technique for diagnosis of an hiatal hernia.

Advantages

  • Barium esophagram and upper GI tests are minimally invasive and generally well tolerated.

  • Degree of hiatal hernia can be assessed and associated ulcers may be discovered.

Disadvantages

  • Exposure to ionizing radiation

III. What are the contraindications for the first-line imaging technique?

  • Pregnancy may be a relative contraindication, although the fetus is not within the direct radiation beam.

IV. What alternative imaging techniques are available?

  • CT (with oral contrast)

  • Radiography (plain film)

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of an hiatal hernia.

CT (with oral contrast)

Advantages

  • CT will demonstrate widening of the diaphragmatic cura.

  • Severity of hiatal and paraesophageal hernias, as well as contents and orientation of the stomach are well demonstrated with CT.

Disadvantages

  • Exposure to ionizing radiation

Plain film

Advantages

  • Hiatal hernias may be incidentally identified on chest radiographs in the retrocardiac region.

Disadvantages

  • Plain film imaging is limited for small hiatal hernias.

  • Hiatal hernia is often an incidental finding and further workup with endoscopy or fluoroscopy is indicated.

VI. What are the contraindications for the alternative imaging techniques?

CT (with oral contrast)

  • Contraindicated in a pregnant patient, especially within the first two trimesters

Plain radiographs

  • No significant contraindications exist.

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