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.