Imaging
Hiatal Hernia
- Preliminary Diagnosis: Hiatal Hernia
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of an hiatal hernia.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of an hiatal hernia.
- VI. What are the contraindications for the alternative imaging techniques?
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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