Indian Journal of Critical Care Medicine
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Year : 2003  |  Volume : 7  |  Issue : 1  |  Page : 56

X-ray Quiz


Correspondence Address:

How to cite this article:
Kelkar A. X-ray Quiz. Indian J Crit Care Med 2003;7:56

How to cite this URL:
Kelkar A. X-ray Quiz. Indian J Crit Care Med [serial online] 2003 [cited 2015 Oct 8];7:56. Available from:

A 52-year-old man, presented with history of chest pain and sweating. His Chest X-Ray showed a suspicious double density through the shadow of left ventricle. He was referred for CT/MRI of chest for further evaluation. This is his Chest X-Ray PA View.
What is your differential diagnosis?
Do you suspect anything? What will you do next?

The CXR shows a double density through the shadow of LV. In addition, a tiny shadow is also seen in the right paraspinal region just below the cardiophrenic angle. This is however, rather subtle. The differential diagnosis with these findings and the clinical story would be an aneurysm, or a left paraspinal neurogenic mass. The Radiologist concerned performed a barium study.
What is the diagnosis?
Besides the differential diagnosis mentioned above, a large obstructed hiatus hernia could exactly look like this. This was suspected rightly and a barium swallow examination was performed instead. These are the films from his barium study.

     Final Diagnosis Top

This is a para-oesophageal type of hiatus that has obstructed. These hernias can present with symptoms and signs identical to ischemic heart disease/angina, in addition to the well-known presenting signs and symptoms of hiatus hernia.

     References Top

1.Yang WT, Metreweli C. Plain radiography and computed tomography of invasive thymomas: Clinico-radiologic-pathologic correlation. Australas Radiol 1997, 41: 118-124.  Back to cited text no. 1    
2.Crowe JK, Brown LR, Nuhm JR. Computed Tomography of the Mediastinum. Radiology 1978; 128: 75-87  Back to cited text no. 2    

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Online since 7th April '04
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