Abstract
Background: Hiatal hernia is not an uncommon condition; however, a large hernia producing symptoms that mimic an acute cardiac condition is extremely uncommon. This clinical case report highlights unusual presentation of hiatal hernia where early recognition and timely intervention were key to ensure favorable patient outcome.
Case summary: We report the case of a 52 years old gentleman with a history of ABO-incompatible living donor liver transplant for hepatitis B related hepatocellular carcinoma, who presented with acute pericarditis like chest pain. Physical examination was unremarkable apart from moderate distress due chest pain. His 12-lead electrocardiogram (ECG) showed a new left bundle branch block (LBBB) with secondary repolarization abnormalities. High sensitivity Troponin-T was serially normal. The total white blood cell count was mildly elevated with normal C reactive protein. A plain chest radiograph showed gas-filled bowel loops in left hemithorax. Further evaluation with computed tomography (CT) showed a 4-5cm left diaphragmatic defect with bowel loops herniating into the left mediastinum. The hernia was surgically corrected. The patient's symptoms and LBBB resolved completely during follow up.
Conclusions: This case presents a mysterious association between a giant hiatal hernia and LBBB and highlights the importance of a broad diagnostic approach in achieving the correct diagnosis.
Keywords
Chest pain, Hiatal hernia, Pericarditis, Case reports, Left bundle branch block