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

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. Background Hiatus hernia is a frequent entity, characterized by the displacement of the gastroesophageal junction and part of the stomach into the mediastinum. Although it may produce symptoms suggestive of cardiac etiology, only few cases of its echocardiographic manifestation have been reported. We present the case of a patient with an apparent left atrial mass on transthoracic echocardiography, which was subsequently identified as hiatus hernia.