Paraesophageal hernia in an elderly woman with vomiting

We describe the case of a 79-year-old woman who presented with resolved episodes of vomiting and was found to have a paraesophageal hernia. Her initial evaluation was unremarkable, and the diagnosis was established only by the use of screening chest radiography. Once the diagnosis was confirmed, the patient required urgent surgical repair. Paraesophageal hernia is a rare clinical entity with the potential for life-threatening complications, making the diagnosis itself an indication for surgery. This case illustrates the fact that significant pathology may be present with few, if any, physical findings in the elderly patient, and thorough evaluations are required for the diagnosis of such occult pathology.