Case Report A Large Intra-Abdominal Hiatal Hernia as a Rare Cause of Dyspnea Cem Sahin, 1 Fatih AkJn, 2 Nesat Cullu, 3 Burak Özseker, 4 Esmail Kirli, 1 and Ebrahim Altun 2 1 Department of Internal Medicine, School of Medicine, Mugla Sıtkı Kocman University, Orhaniye Mahallesi ˙ Ismet Catak Caddesi, Merkez, 48000 Mugla, Turkey 2 Department of Cardiology, School of Medicine, Mugla Sıtkı Kocman University, Orhaniye Mahallesi ˙ Ismet Catak Caddesi, Merkez, 48000 Mugla, Turkey 3 Department of Radiology, School of Medicine, Mugla Sıtkı Kocman University, Orhaniye Mahallesi ˙ Ismet Catak Caddesi, Merkez, 48000 Mugla, Turkey 4 Department of Gastroenterology, School of Medicine, Mugla Sıtkı Kocman University, Orhaniye Mahallesi ˙ Ismet Catak Caddesi, Merkez, 48000 Mugla, Turkey Correspondence should be addressed to Cem Sahin; cemsahin@mu.edu.tr Received 19 March 2015; Revised 8 June 2015; Accepted 16 June 2015 Academic Editor: Jesus Peteiro Copyright © 2015 Cem Sahin et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Giant hiatal hernias, generally seen at advanced ages, can rarely cause cardiac symptoms such as dyspnea and chest pain. Here, we aimed to present a case with a large hiatal hernia that largely protruded to intrathoracic cavity and caused dyspnea, particularly at postprandial period, by compressing the lef atrium and right pulmonary vein. We considered presenting this case as large hiatal hernia is a rare, intra-abdominal cause of dyspnea. 1. Introduction Hiatal hernia is defned as abnormal protrusion of stomach with another intra-abdominal organ, in some cases, above diaphragm from esophageal hiatus. Its prevalence has been reported as 0.8–2.9% in upper gastrointestinal endoscopy series. Symptoms are ofen related to gastroesophageal refux disease in the hiatal hernia which is usually asymptomatic. However, although rarely seen, a hiatal hernia can cause atypical symptoms such as chest pain or dyspnea due to the extent of hernia and organs protruded into thorax cavity. Here, we aimed to present a case with a hiatal hernia that largely protruded into thorax cavity and compressed lef atrium, causing dyspnea. 2. Case Presentation An 84-year-old woman presented to the outpatient clinic with increasing fatigue, shortness of breath, and blackening of the stool over 1 month. She noted that shortness of breath aggravated with exertion and afer the ingestion of food. Te patient did not describe an underlying chronic disease and did not use any medication within the previous 6 months. On the physical examination, vital signs were stable and pallor was observed at conjunctiva. No abnormal physical examination fnding was observed in the patient other than systolic murmur at apex on the cardiac examination. In the laboratory evaluations, the following results were obtained: WBC, 7400/mm 3 ; Hgb, 10.9 g/dL; MCV, 72.3 fL; Plt, 376.000/mm 3 ; iron, 18 g/dL; iron binding capacity, 350 g/dL; ferritin, 3,7 ng/mL. Fecal occult blood test was positive. Biochemical parameters were found to be within the normal range. On the posterioanterior chest radiograph, increased cardiothoracic index, enlarged mediastinum, and a mass appearance with an air-fuid level superposed with car- diac contours were observed (Figure 1). A thoracoabdominal CT scan including axial and coronal sections was performed in the patient because of the suspicion of a large hiatal hernia with available image. It was found that a large part of the stomach was herniated into mediastinum without any fnding of incarceration and gastrointestinal obstruction and that Hindawi Publishing Corporation Case Reports in Cardiology Volume 2015, Article ID 546395, 4 pages http://dx.doi.org/10.1155/2015/546395