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A woman with intermittent heartburn

BMJ 2017; 357 doi: (Published 27 April 2017) Cite this as: BMJ 2017;357:j1936
  1. Hao Chen, consultant radiologist
  1. Department of radiology, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
  1. Correspondence to H Chen poetyoung{at}

A 68-year-old woman presented to the hospital with intermittent retrosternal heartburn that had been ongoing for several years. Physical examination and electrocardiogram revealed no abnormalities. A plain chest radiograph was obtained (fig 1). What does the radiograph show?

Fig 1

Chest radiograph


The chest radiograph shows retrocardiac opacity consistent with a diagnosis of hiatal hernia.


The differential diagnoses for a retrocardiac opacity include retromediastinal tumour, aortic aneurysm, and spinal abscess. The patient’s stable condition, mild symptoms, the presence on radiology of an air shadow (fig 2, white arrow) inside the rounded opacity (fig 2, black arrows), and absence of the normal stomach …

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