GI Radiology > Hernia > External > Hiatal

Hiatal Hernia

A hiatal hernia is the abnormal protrusion of the esophagus and/or stomach through the esophageal hiatus. These hernias occur at the esophago-gastric junction.

The image below represents the normal anatomical relationships. The A-line marks the beginning of the ampulla. The B-line marks the junction between the squamous esophageal mucosa and the columnar gastric mucosa.

There are two main types of hiatal hernias: sliding (axial) and rolling (paraesophageal). Roughly 99% of hiatal hernias are sliding and 1% are paraesophageal.

Sliding hiatal hernias occur when the B line is in the mediastinum, typically 2 cm above the diaphragm.

Paraesophageal hiatal hernias have a normal esophago-gastric junction, but the gastric fundus extends through the esophageal hiatus into the mediastinum. These hernias are dangerous, and potentially life threatening, because of the risk of volvulus and incarceration.

An upper GI barium series is the preferred examination for fully evaluating hiatal hernias. Hiatal hernias are often found incidentally, however, on CT scans and routine chest radiographs.


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