doi: 10.5505/abantmedj.2014.24085 Abant Medical Journal Olgu Sunumu / Case Report Volume Cilt 3 Issue Sayı 3 Year Yıl 2014 İletişim Bilgisi / Correspondence 293 Uzm. Dr. Hasan Kocatürk, Erzurum özel şifa hastanesi Erzurum - Türkiye E-mail: haskturk@hotmail.com Geliş tarihi / Received: 28.09.2013 Kabul tarihi / Accepted: 01.01.2014 Çıkar Çatışması / Conflict of Interest: Yok / None Compression of the heart chambers by the gastric structures Kalp Boşluklarına Bası Yapan Sindirim sistemi Organları Hasan Kocatürk 1 , Volkan Yurtman 2 , Leyla Karaca 3 1 Erzurum Şifa Hastanesi Kardiyoloji 2 Erzurum Şifa Hastanesi Kalp Damar Cerrrahisi 3 Erzurum Şifa Hastanesi Radyoloji Özet Abstract Kalp boşluklarının komşu yapılar veya sindirim organları tarafından basıya uğraması kalp hastalığına benzer semp- tomlara neden olabilmektedir. Burada sindirim organ- larının herniasyonunun kalp boşlukları üzerinde semp- tomatik basısına neden olan iki olgu sunulmuştur. Yorgun- luk ve nefes darlığı ile başvuran ilk vaka da ekokardiyografi de sol atriumun posterior tarafından bası yapan ekolusent kitle tespit edilmiş, kesin tanı için çekilen bilgisayarlı to- mografi de bunun bir hiatal herni olduğu saptanmıştır. Bir kaç aydır eforla artan yorgunluk ve alt ekstremitelerde ödem ile başvuran 62 yaşındaki ikinci vakada, sağ kalp boşlukları üzerine baskı yapan büyük bir diyafragmatik gastrik herni tespit edildi. Burada sunulan hastalarda diyafragmatik ve hiatal herni tanıları öncelikle ekokardiyo- grafi ile daha sonrada tomografi ile konulmuştur. Ekokar- diyografide herni keselerinin kalp boşlukları üzerindeki bası yapıcı etkisi açıkça tespit edilmiştir. Heart chamber compression by neighboring structures or digestive organs can give clinically symptoms mimicking intrinsic heart diseases. We describe here two persons who developed gastric hernia leading to symptomatic compres- sion on heart chambers. The first case presented with chief complaint of fatigue and shortness of breath. Echocardio- gram revealed an echolucent mass showing compression on the posterior aspect of the left atrium. Computed tomo- graphic imaging ultimately identified that the mass was a hiatal hernia sac. The second case was a case of a large diaphragmatic hernia associated with right atrium and right ventricular compression in a 62 year old man who present- ed with increasing effort fatigue and pitting edema in lower extremities during the previous months. The present diag- nosis of hiatal and diaphragmatic hernia was made firstly on the basis of echocardiogram and subsequent computed tomography. Echocardiography showed clearly the com- pressive effect of the hernia sacs on the heart chambers. Anahtar Kelimeler: Sindirim organları, hiatal herni, di- yafragmatik herni, kalp boşlukları. Keywords: Gastric structures, hiatal hernia, diaphragmatic hernia, heart chambers. Introduction Case 1 Extrinsic heart chambers compression is a rare phenomenon but has important clinical conse- quences mimicking heart disease (1). Mediasti- nal structures causing heart chambers com- pression with varying degree are gastrointesti- nal tract diseases; mediastinal masses (thy- moma/schwannoma, mediastinal lymphoma, thymic cyst, teratom cyst); pulmonary diseases (lung tumor, bronchogenic cyst) and aor- ta/pericardial diseases (ascending/ descending aortic aneurysm, hematoma from rupture of type B aortic dissection, pericardial cyst and hematoma) (2). The esophagus and the de- scending aorta would be expected more to produce left atrial compression because of anatomic proximity (2).We report two cases of gastric hernia, in one who had hiatal hernia leading to left atrial compression and in other who had a large diaphragmatic hernia com- pressing the right heart chambers. A 68 year-old woman presented with fatigue and shortness of breath, worsening during the past 2 months. The patient's vital signs were as follows: pulse rate, 95 beats/min; respiration rate, 17 breaths/min; and blood pressure, 140/90 mm Hg. A grade 2/6 systolic ejection murmur was heard over the left sternal border. Her chest was clear to auscultation bilaterally. Because the patient’s symptoms was con- sistent with congestive heart failure, although in the absence of considerable clinical signs, Transthoracic echocardiography (TTE) was per- formed and showed incidentally an echolucent mass having a maximum diameter of 70 x90 mm and compressing the left atrium from pos- terolateral site. Also noted were normal left ventricular function, an ejection fraction of 61, and mild mitral valve regurgitation. For further evaluation of this extracardiac echolucent mass, contrast echocardiography was also per- formed. This revealed no microbuble or flow in