UMEM Educational Pearls


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


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

Bonus Pearl

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