Hiatus hernia .. Radiology
هذا اول موضوع اطرحه في المنتدى واتمنى ان تستفيدوا منه.. ورجاء من قراء مواضيعي عدم نقله الى المنتديات الاخرى او التصرف به دون الرجوع الي بصفتي كاتبة الموضوع..
هذا الموضوع عن مرض Hiatus hernia، وكيفية طهورة في فحوصات الاشعاعية..
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Definition and classification
Hiatus hernia is an acquired disease occurs when a protrusion of a part of the stomach upward through the diaphragm. It’s common in elderly people.
Types of hiatus hernia are sliding HH and paraoesphageal HH; you can see the difference between these two types in the images bellow:
Sliding HH
Sliding HH is when the hernia slips up and down through the cardiac sphincter, as a result gastroesophageal junction (Jn) is placed above the diaphragmatic hiatus.
Paraoesphageal HH
Paraoesphageal HH is when the hernia fixed above the diaphragm, but gastroesophageal junction is in normal location.
Etiology
The exact cause of a hiatal hernia is not known, but there are several factors cause hiatus hernia:
• Lifestyle
• Congenital defects
• Heredity
• Trauma
• Reduction of the esophagus length
What happen
The reasons above can cause weakening of tendons of the diaphragm which support the tissues of oesophageal hiatus; therefore, the opening of the oesophageal hiatus become larger than normal and the upper part of stomach inters the thoracic cavity. HH usually associated with gastroesophageal reflux that affects the lining tissues of oesophagus by irritating and damaging it, so it may cause oesophagitis, ulcer, stricture, or malignancy.
In some conditions hiatal hernia causes cut off the blood supply to the trapped portion of the stomach cause a great pain and serious illness. Also, hiatal hernia affects other organs functions such oesophagus, heart and lungs, and result pressure changes between the abdominal and thoracic cavities during breathing. (For more info u can see this website http://www.emedicine.com/radio/topic337.htm )
Signs & Symptoms
Signs
• Choking, coughing, or shortness of breath.
• Vomiting, blood or having black, tarry stools
• Weight loss
• Anemia
Symptoms
• Dyspepsia
• Epigastria pain
• Heartburn
• Chest pain or pressure
• Dysphagia
• Coughing
• Belching
• Hiccups
• Vomiting, blood or having black, tarry stools
• Weight loss.
Treatment
• Medications
• Surgery
• Also self-care at home
Prognosis
The prognosis depends on the type of the HH:
• Paraesophageal hernias CAN BE life threatening
• Mostly the symptoms are alleviated with treatment
:
:
Imaging techniques used to demonstrate the disease
Plain film:
Chest x-ray: the hernia may be seen as a retrocardiac mass or a soft tissue mass in posterior mediastinum see image (1) it is with or without an air-fluid level (air-fluid level may be absent in supine position so it’s necessary to take the image erect). In some images this disease showed as mimic cardiomegaly image (2) (Khan). Projections that may perform are PA and Lateral.
image (1) SEE STOMACH GAS BUBBLE BELOW DIAPHRAGM
()
Barium meal, follow through
the radiologist will take some spot views of the stomach. Then the radiographer will take 15 min supine / prone AXR including diaphragm for proximal small bowel. After that he will take a view every 30 min until contrast is seen large colon (supine / prone AXR). The projections which radiographers may take are RAO, PA, right lateral, LPO and AP.
(in UK the radiographer do this examination)
Normal Barium Meal
Abnormal
a) Sliding: stomach and gastro-oesophageal junction (arrow) above the diaphragm.
b) Rolling: part of the stomach herniated through the oesophageal hiatus above the diaphragm but gastro-oesophageal junction is below the diaphragm.
Other modalities also can be used such as
• CT
• MRI
• US
• Radionuclide studies
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DO NOT copy this report or use it without the writer permission
B.M
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