CTICasesIntrathoracic Gastric Herniation with Pseudo-Pneumothorax Post-Hiatal Hernia Repair
Imaging findings
A chest radiograph shows dramatically abnormal findings with rightward deviation of the mediastinum, opacity in the left hemithorax, and a curvilinear interface, initially concerning for tension pneumothorax. A chest tube placed in the left hemithorax did not decompress the 'pseudo-pneumothorax.' CT confirms a distended stomach herniated almost entirely into the left hemithorax through a defect near the esophageal hiatus, causing left lung compression. A small perforation in the posterior stomach was found during subsequent surgery.
Key takeaways
Post-surgical complications, especially after hiatal hernia repair, can include re-herniation of abdominal organs into the chest. A 'pseudo-pneumothorax' with mediastinal shift should raise suspicion for intrathoracic herniation of viscera, particularly when a chest tube fails to alleviate symptoms or findings. The stomach can become obstructed and compromise the surrounding lung.
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