Question

67 yo male presents with burning substernal chest pain; worse with meals and when supine. What's the diagnosis?

Answer

Answer: Hiatal hernia

• Hiatal hernias are commonly retrosternal and present with GERD-like symptoms
• A barium swallow is the diagnostic test of choice.

The differential diagnosis for circumscribed air-fluid levels on chest X-ray includes:

• Hiatal hernia
• Cavitary disease (e.g., tuberculosis)
• Empyema
• Lung abscess

Bonus Pearl

Do you like listening to pre-recorded lectures, especially when they’re free? Then check out Free Emergency Medicine Talks (http://freeemergencytalks.net) where you can listen to millions (ok, more like 1,384) of free lectures recorded at major conferences around the world.

Follow me on Twitter (@criticalcarenow) or Google+ (+haney mallemat)