Correct assessment of unusual hiatus hernia with magnetic resonance imaging

A 54-year old woman presented with a year long history of increasing dyspnoea and orthopnoea. The chest X-ray and CT scan suggested bilateral hemidiaphragmatic elevation (Fig. 1a and b). Subsequent MRI demonstrated normal position of both hemi-diaphragms and diagnosis of massive hiatus hernia was made (Fig. 2). Herniated stomach, omentum and colon were confirmed intraoperatively. Figure 1: Chest X-ray suggested bilateral hemidiaphragmatic elevation (black arrows) due to suspected diaphragmatic palsy or eventration (a). Coronal CT scan findings were equivocal (b). Figure 2: Magnetic resonance imaging clearly demonstrated normal position of both hemidiaphragms (white arrows) and correct diagnosis of a massive hiatus hernia was made.