UMEM Educational Pearls

Title: What s the Diagnosis? Case submitted and written by Dr. Zachary Dezman

Posted: 4/15/2012 by Haney Mallemat, MD (Emailed: 4/16/2012) (Updated: 4/16/2012)
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Question

67 yo male presents with burning substernal chest pain; worse with meals and when supine. What's the diagnosis?

Answer

Answer: Hiatal hernia

Hiatal hernias are commonly retrosternal and present with GERD-like symptoms
A barium swallow is the diagnostic test of choice.

The differential diagnosis for circumscribed air-fluid levels on chest X-ray includes:

Hiatal hernia
Cavitary disease (e.g., tuberculosis)
Empyema
Lung abscess

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