Figure 14 - Computed tomography image through the chest showing a type IV paraesophageal hiatal hernia.

In this example, the sigmoid colon (containing contrast) is clearly evident adjacent to the heart (also contrast enhanced). Lower cuts show the patient to be postsplenectomy, consistent with the observation that paraesophageal herniation occurs most commonly after surgical dissection in the area of the hiatus. (Source: Kahrilas and Pandolfino,⁷⁵ with permission.)