CTICasesEsophagopleural fistula closed with Ovesco clip
Imaging findings
Chest CT and barium swallow show a large hiatal hernia containing a herniated stomach within the chest. There is extraluminal gas in the mediastinum confined within the hernia sac, and a fluoroscopic study shows contrast leakage from a perforated gastric ulcer in the intrathoracic stomach.
Key takeaways
Perforation of an intrathoracic gastric ulcer within a hiatal hernia is a rare complication that presents with chest or epigastric pain. The resulting extraluminal air and contrast leak may be confined within the hernia sac (due to the peritoneal covering), preventing free pneumomediastinum and direct communication with the wider mediastinum.
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