Hiatal hernia with intrathoracic communicating hydrocele
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Hiatal hernia refers to the herniation of intra-abdominal elements into the mediastinum through the oesophagus hiatus. Hiatal hernia can be classified as sliding and paraesophageal, for which sliding hiatal hernia accounts for most of the cases. It is caused due to the circumferential laxity or localized defect of a pharyngoesophageal membrane.A 72-year-old man with alcoholic liver cirrhosis presented to our clinic with the chief complaints of shortness of breath and abdominal distension for one week. Upon physical examination, diffuse wheezes were auscultated bilaterally. The abdomen was distended with presence of umbilical hernia and shifting dullness. His lower limbs showed pitting edema. The chest radiography showed a huge and well-circumscribed mass lesion originating from the mediastinum. Passive atelectasis of left lower lung was also noted, compressed by the ascites-containing peritoneal sac. Hiatal hernia with intra-thoracic communicating hydrocele was diagnosed. Furosemide and spironolactone were initiated for ascites control...

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