CTICasesMassive Hiatal Hernia with Intrathoracic Appendix and Recurrent Esophageal Cancer with Left Atrial Tumor Thrombus
Imaging findings
CT shows a massive hiatal hernia containing a herniated colon, the cecum, and a blind-ending, non-inflamed intrathoracic appendix running along the left ventricle and mediastinum. Additionally, there is a soft-tissue mass at the subcarinal region encasing the right main bronchus, which directly invades the left atrium, presenting as a soft tissue filling defect consistent with tumor thrombus.
Key takeaways
This multi-finding case highlights a very rare occurrence of an intrathoracic appendix within a massive hiatal hernia alongside a biopsy-proven recurrence of esophageal cancer. Tumor thrombus invading the left atrium via direct extension is a known but rare complication of advanced esophageal or bronchogenic carcinoma, and must be distinguished from bland thrombus. Finding the cecum and appendix within a hiatal hernia is an extremely unusual anatomic variant resulting from extensive bowel herniation.
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