Hiatal Hernia on HRCT Scans | IPF Radiology Rounds

The majority of patients with IPF have pathological gastroesophageal reflux,^13,14 though the clinical implications of reflux on the IPF disease course are not fully understood.⁵ The presence of hiatal hernia is implicated as a cause of gastroesophageal reflux, and it has been hypothesized that the incidence of hiatal hernia may be higher in patients with IPF than those with other lung diseases including asthma or COPD.¹⁵

Hiatal hernia may be distinguished on HRCT by evaluating the location of the esophagus in relation to the diaphragm.¹⁵ For a proper diagnosis of hiatal hernia, the lower esophageal ring must be ≥1-2 cm above the level of the diaphragmatic hiatus.^15,16

Distinguishing Honeycombing and Paraseptal Emphysema

Signs of Connective Tissue Disease

Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline

Reference

5. Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183:788-824.

13. Raghu G, Freudenberger TD, Yang S, et al. High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis. Eur Respir J. 2006;27:136-142.

14. Tobin RW, Pope CE, Pellegrini CA, et al. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1998;158:1804-1808.

15. Noth I, Zangan SM, Soares RV, et al. Prevalence of hiatal hernia by blinded multidetector CT in patients with idiopathic pulmonary fibrosis. Eur Respir J. 2012;39:344-351.

16. Dodds WJ. 1976 Walter B. Cannon Lecture: current concepts of esophageal motor function: clinical implications for radiology. Am J Roentgenol. 1977;128:549-561.