An 82-year-old man was referred to our clinic
for cardiac evaluation before inguinal hernia repair
surgery. His previous medical history revealed
hypertension and coronary artery disease. The patient
was asymptomatic, and his physical examination
was unremarkable. A 12-lead electrocardiography
demonstrated normal sinus rhythm with firstdegree
atrioventricular block. Transthoracic
echocardiography (TTE) showed regional wall
motion abnormalities and left ventricular ejection
fraction was 50% as assessed by the Simpson"s
method. Additionally, TTE parasternal long
axis view, apical four-chamber view and apical
long axis view demonstrated compression of the
left atrium by an extrinsic, hyperechoic mass
(Figure 1a-c). Thoracic computed tomography
revealed a large sliding type hiatus hernia with
intrathoracic extension to the posterior mediastinum
and compression of left atrium from the posterior
aspect (Figure
1d, e).
Figure 1: (a) Transthoracic echocardiographic parasternal long
axis view, (b) apical four-chamber view and (c) apical long axis
view showing extrinsic compression of the left atrium by a large
mass (arrows). (d) Axial and (e) sagittal computed tomography
scans showing a large sliding type hiatus hernia compressing to
the left atrium from posterior mediastinum (arrows).
RV: Right ventricle; LV: Left ventricle; Ao: Aorta; LA: Left atrium; RA: Right
atrium; HH: Hiatus hernia.
Hiatal hernia is defined as the protrusion of
an organ, typically the stomach, from abdomen
to thorax through the esophageal hiatus in the
diaphragm and is usually associated with symptoms
of gastroesophageal reflux disease.[1] Rarely, large
hiatal hernias may lead to cardiac symptoms
and complications such as dyspnea and exercise
impairment, recurrent acute heart failure, anginalike
chest pain and electrocardiographic changes
due to its mechanical compression.[2-5] In some
cases, hiatal hernia may mimic a left atrial mass
and is diagnosed incidentally on TTE.[6]
Declaration of conflicting interests
The authors declared no conflicts of interest with respect to
the authorship and/or publication of this article.
Funding
The authors received no financial support for the research
and/or authorship of this article.