Chest X-ray Findings
Hiatal Hernia usually presents radiographically as a well-defined, rounded, retrocardiac opacity with an air-fluid level. In many cases of hiatal hernia, there will not be an air bubble below the left hemidiaphragm. This is a relatively expected finding considering that the stomach is no longer in its usual position.
Round Retrocardiac Opacity
Air-Fluid Level
Pitfalls
One pitfall to consider is that hiatal hernias can look similar to a retrocardiac lung abscess or another cavitary lesion, but it will change in size and shape between radiographs. Large hernias can shift the mediastinum to the right and result in a widening of the carinal angle. They can even give the appearance of cardiomegaly. In the radiograph above, the cardiac silhouette is distinctly visible within the confines of the hiatal hernia.
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