PMC5425284_01
(A) Axial section of CT chest angiogram illustrating herniation of the pancreas (star) into the mediastinum. (B) Coronal section of CT chest angiogram illustrating herniation of the pancreas (star) above the level of the diaphragm (arrow) into the mediastinum, with associated free fluid (arrow heads) secondary to pancreatitis. Other notable structures: liver (L) and stomach (S).
CG-CGCR170036F001.jpg
PMC5425284_01_CG-CGCR170036F001.jpg
F1
However, a large intrathoracic hiatal hernia containing the stomach, proximal duodenum, and the body and tail of the pancreas was noted, with perigastric fluid in the posterior mediastinum and mesenteric stranding thought to be secondary to pancreatitis (Figure 1).
Coronal section of MRCP rotated 180 , confirming herniation of the pancreatic duct (arrow heads) above the level of the diaphragm (arrow). Other notable structures: heart (H), stomach ruggae (SR), gallbladder (GB), and bowel (B).
CG-CGCR170036F002.jpg
PMC5425284_01_CG-CGCR170036F002.jpg
F2
Subsequent magnetic resonance cholangiopancreatography (MRCP) revealed a normal gallbladder without cholelithiasis and the transhiatally herniated pancreas with associated stranding and trace fluid, but no evidence of necrosis or fluid collections (Figure 2).