A patient of chest tightness with a left atrial mass on echocardiography - Hiatal hernia: Case report

A wide spectrum of diseases may present manifestations suggestive of acute cardiovascular events. Appropriate acquisition and interpretation of echocardiography is important for making differential diagnosis, but the imaging can also be deceiving. We hereby report a case presented with chest tightness who was found to have a mass encroached on the left atrium in transthoracic echocardiography (TTE). The mass-like lesion was found to be caused by hiatal hernia in the following computed tomography examination. Three features were observed in the TTE: (1) the visceral and parietal pericardia were observed in the apical four-chamber view, implying that the mass was located in the extra-atrial region, (2) we could reveal the dynamic stomach contents and air by changing the echo density over time, and hyperechoic density was observed all the time over the upper site of the mass, indicating gases in a hollow organ, and (3) a typical mass was shown in parasternal long axis view and apical four-chamber view, but not in apical five-chamber view. This case reminds us the importance of confirmatory medical imaging, and we present images from different diagnostic tools of this case. In particular, the echocardiography images of the hiatal hernia are rarely presented in the literature.