An Unusual Cause of Chest Pain and Dyspnea in an Elderly: Giant Intrathoracic Haital Hernia

Abstract

Richmond Ronald Gomes

Giant hiatal hernias, generally seen at advanced ages, can rarely cause cardiorespiratory symptoms such as dyspnea and chest pain. Here, we aimed to present a case with a large hiatal hernia that largely protruded to intrathoracic cavity and caused dyspnea, particularly at postprandial period. We report a case of a 74-year-old female who presented with one-month history of progressive shortness of breath and left sided chest pain. Upon arrival, the patient was found to be hypoxic with oxygen saturation 90% on room air. Physical examination also showed decreased breath sounds on left mid to basal lung with shifting of trachea and apex beat to right side. Plain radiograph demonstrated an increased opacity at the left lower lobe with retro-cardiac air fluid level; Subsequent computerized tomography of the chest revealed a giant hiatal hernia, containing stomach, duodenum, colon and spleen. This case highlights the giant hiatal hernia as an unusual cause of shortness of breath and chest pain, especially in elderly patients.

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