To cite: Stephens M, Hughes A. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013009683 DESCRIPTION A 61-year-old man with recently diagnosed gastrooesophageal reflux disease re-presented to his primary care physician due to persisting epigastric and pharyngeal pain refractory to maximal proton pump inhibitor therapy. Examination was unremarkable. Endoscopy with...

Diagnosis of a hiatal hernia (HH) is typically made using an upper gastro-intestinal barium X-ray. A complementary test is gastroscopy or upper-intestinal endoscopy. There are reports in which HH has been diagnosed by echocardiography. We here describe a case of a HH visible on an echocardiogram in a female with palpitations.

BACKGROUND We present a case of a lumbar hernia and a review of the literature of this rare hernia type. CASE REPORT The case and the review will discuss the unusual presentations reported, common etiologies, the importance of early operative repair based on the high rate of incarceration and the recent recommendations regarding repair techniques. CONCLUSIONS Lumbar hernias are rare cases, ...

A n 82-year-old lady, with a long history of syncopal spells that were occasionally associated with meals, was referred for transÔesophageal echocardiography (T√E) because of a large left atrial mass identified on transthoracic echocardiography (Figure 1A). T√E was able to visualise only a part of the left atrium and the ascending aorta (Figure 1B & C), and when the probe was further advanced, ...

Diagnosis of a hiatal hernia (HH) is typically made using an upper gastro-intestinal barium X-ray. A complementary test is gastroscopy or upper-intestinal endoscopy. There are reports in which HH has been diagnosed by echocardiography. We here describe a case of a HH visible on an echocardiogram in a female with palpitations.

We present a patient with a large hiatal hernia resulting in duodenogastric reflux that was seen as abnormal activity below and behind the heart (retrocardiac) on SPECT images and on (99m)Tc-tetrofosmin cardiac SPECT raw-data projection images. Incidental findings such as extra- and retrocardiac activity in the thorax and abdomen should be included on all comprehensive cardiac SPECT reports.

: Hiatal hernias are common and generally correlated with obesity increasing age. However, many individuals have no symptoms never diagnosed, thus it’s hard to establish the real prevalence of hiatal hernias. To pursue a diagnosis hernia is not necessary in asymptomatic patients, but symptomatic ones need evaluation should be considered for surgical repair. The clinical workup based on patient'...