Detection of Hiatus Hernia on 4 x 10 Chest Survey X-ray Films

¹ Tuberculosis Control Physician of the Kankakee State Hospital.

Hiatus hernia, frequently due to hiatal relaxation or incompetence, is relatively common in the pyknic individual over 50. Three cases are illustrated, these being selected from 21 proved hiatus hernias, detected on 4 x 10 chest survey among 4,200 patients of a hospital for the mentally ill.

On a plain chest view (4 x 5 or 14 x 17), the presence of a hiatus hernia may be presumed when a supradiaphragmatic fluid level, a gas bubble, or a rounded opacity is visualized through the heart shadow, or protruding into either cardiophrenic angle. Sometimes, the condition cannot be suspected from the scout film; the reasons for this are analyzed.

Suggestions for a more frequent detection of hiatus hernia from 4 x 5 or 14 x 17 plates include: (a) ingestion of a carbonated drink before exposure of routine chest x-rays, (b) high KVP technique, and (c) alertness for variations in the density of the cardiac shadow.