Two- and three-dimensional transthoracic echocardiographic assessment of hiatal hernia

Using two- (2DTTE) and three-dimensional transthoracic echocardiography (3DTTE) and an oral contrast agent (a carbonated beverage), a mass-like lesion behind the left ventricular posterior wall in an elderly female was definitively diagnosed as a hiatal hernia. A 3DTTE provided a more comprehensive evaluation of the hiatal hernia as compared to the 2DTTE in terms of its size and extent and thickness of the wall. The size of the hernia was underestimated by 2DTTE (3.3 x 3.2 cm) as compared to 3DTTE (at least 7 x 4.8 cm). The maximum thickness of the gastric wall was also found to be larger by 3DTTE (11 mm) as compared to 2DTTE (5 mm). Both the size of the hernia and thickness of the wall have important clinical implications. The size has been reported to be the strongest predictor of severity of esophagitis and gastric wall thickness of 10 mm or more has been associated with malignant or potentially malignant gastric lesions.