What’s the Giant Bubble Seen Through the Heart?

Case History

This 75 year old female patient presents with a history of gastrointestinal reflux dysphasia (GERD).

Radiographic Findings

Note the very large air fluid level seen through the heart on the frontal images, and in the retrocardiac space just posterior to the left ventricle. This large air bubble represents the fundus of the stomach (Magenblasse). This patient has approximately two-thirds of their stomach in their thorax and represents a huge sliding hiatal hernia.

A frequent symptom of hiatal hernia is acid reflux to the esophagus. This patient is likely sleeping with two or three pillows elevating their head. Not all sliding hiatal hernias are symptomatic but one this size certainly was. Follow up with a gastroenterologist is recommended.

Motor Vehicle Accident – Rule out Fracture

Case History

This young male patient was in a recent motor vehicle accident and presents with cervical spine pain.

Radiographic Findings

Observe the hypoplasia of the C5 and C6 vertebral bodies which represents a mild form of a congenital block vertebrae. Note the anterior bony densities in front of the disc space between C5 and C6. This bony density could be confused with calcification of the anterior longitudinal ligament or an intercalary bone. However, this is a very characteristic appearance of congenitally elongated transverse processes of C5 and C6. This is a developmental variant with no clinical significance and should not be confused with any form of fracture. Congenital block vertebrae frequently present with fusion of the posterior facets, lamina, and spinous processes. This patient had no fusion of the facets or lamina. Of incidental notation is a small calcified nuchal bone present posterior to C6. This is not symptom generating.

COMPLICATIONS FOLLOWING SPINAL FUSION

Surgical arthrodesis has occurred between C6 and C7 across the disc space. There have been threaded screws placed within the vertebral body of C4 and C5 and both screws on the inferior aspect have been fractured. This can produce instability and may require surgical correction. This case demonstrates two different types of spinal fusion, one done by bone graft and one done by metallic fixation.