Preliminary Diagnosis: Hiatal Hernia
I. What imaging technique is first-line for this diagnosis
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Fluoroscopic guided barium study (esophagram or upper GI)
II. Describe the advantages and disadvantages of this technique for diagnosis of an hiatal hernia.
Advantages
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Barium esophagram and upper GI tests are minimally invasive and generally well tolerated.
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Degree of hiatal hernia can be assessed and associated ulcers may be discovered.
Disadvantages
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Exposure to ionizing radiation
III. What are the contraindications for the first-line imaging technique?
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Pregnancy may be a relative contraindication, although the fetus is not within the direct radiation beam.
IV. What alternative imaging techniques are available?
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CT (with oral contrast)
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Radiography (plain film)
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of an hiatal hernia.
CT (with oral contrast)
Advantages
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CT will demonstrate widening of the diaphragmatic cura.
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Severity of hiatal and paraesophageal hernias, as well as contents and orientation of the stomach are well demonstrated with CT.
Disadvantages
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Exposure to ionizing radiation
Plain film
Advantages
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Hiatal hernias may be incidentally identified on chest radiographs in the retrocardiac region.
Disadvantages
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Plain film imaging is limited for small hiatal hernias.
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Hiatal hernia is often an incidental finding and further workup with endoscopy or fluoroscopy is indicated.
VI. What are the contraindications for the alternative imaging techniques?
CT (with oral contrast)
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Contraindicated in a pregnant patient, especially within the first two trimesters
Plain radiographs
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No significant contraindications exist.
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