Clinical introduction

An 82-year-old woman presented to the ED with complaint of severe epigastric pain since last 2 days. The pain was progressive in severity and associated with vomiting. Physical examination revealed mild epigastric tenderness and bibasilar crepitations while the ECG was unremarkable. Laboratory tests were within normal range. A frontal chest radiograph was obtained (figure 1).

Question

• Which organ is the most probable cause of epigastric pain, based on the radiographic findings?

  1. Lung and pleura

  2. Ribs

  3. Thymus

  4. Stomach

Answer D

The frontal chest radiograph (figure 2) shows a large opacity in the retrocardiac region with an air–fluid level. The borders of the opacity extend beyond the cardiac shadow. These findings are suggestive of herniation …